High-density Lipoprotein-cholesterol Subfractions and Coronary Artery Calcium: The ELSA-Brasil Study

Giuliano Generoso, Isabela M. Bensenor, Raul D. Santos, Henrique L. Staniak, Rodolfo Sharovsky, Itamar S. Santos, Alessandra C. Goulart, Steven R. Jones, Krishnaji R. Kulkarni, Michael J. Blaha, Peter P. Toth, Paulo A. Lotufo, Marcio S. Bittencourt

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Although elevated high-density lipoprotein cholesterol (HDL-C) is considered protective against atherosclerotic cardiovascular disease, no causal relationship has been demonstrated. HDL-C comprises a group of different subfractions that might have different effects on atherosclerosis. Our objective was to investigate the association between HDL-C subfractions with the coronary artery calcium (CAC) score. Methods: We included 3,674 (49.8 ± 8.3 years, 54% women) participants from the ELSA-Brasil study who had no prior history of CVD and were not currently using lipid-lowering medications. We measured the fasting lipoprotein cholesterol fractions (in mmol/l) by a zonal ultracentrifugation method (VAP). We analyzed the independent predictive values of total HDL-C, HDL2-C, and HDL3-C subfractions and in the HDL2-C/HDL3-C ratio using linear regression to predict Ln(CAC+1) and logistic regression to predict the presence of CAC. Results: Overall 912 (24.8%) of the participants had CAC>0, and 294 (7.7%) had CAC>100. The mean total HDL-C, HDL2-C, and HDL3-C were: 1.42 ± 0.37, 0.38 ± 0.17 and 1.03 ± 0.21 mmol/l, respectively. Individuals with CAC>0 had lower levels of total HDL-C as well as of each subfraction (p < 0.001). When adjusted for age, gender, smoking, hypertension, alcohol use, physical activity, and LDL-C, we observed an inverse association between HDL-C and its subfractions and CAC (p < 0.05). However, by adding triglycerides in the adjustment, neither total HDL-C nor its subfractions remained independently associated with the presence or extent of CAC. Conclusion: In this cross-sectional analysis, neither the total HDL-C nor its subfractions (HDL2-C and HDL3-C, as well as HDL2-C/HDL3-C ratio) measured by VAP are independently associated with the presence or extent of coronary calcification.

Original languageEnglish (US)
Pages (from-to)362-367
Number of pages6
JournalArchives of Medical Research
Volume50
Issue number6
DOIs
StatePublished - Aug 2019

Keywords

  • CAC
  • Coronary calcification
  • HDL-C
  • Subclasses
  • Subclinical atherosclerosis
  • Subfractions

ASJC Scopus subject areas

  • Medicine(all)

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