Lipid phenotypes at the extremes of high-density lipoprotein cholesterol

The very large database of lipids-9

Renato Quispe, Mohammed Al-Hijji, Kristopher Swiger, Seth Martin, Mohamed B. Elshazly, Michael Blaha, Parag H. Joshi, Roger S Blumenthal, Allan D. Sniderman, Peter P. Toth, Steven Jones

Research output: Contribution to journalArticle

Abstract

Background Low serum levels of high-density lipoprotein cholesterol (HDL-C) are an important risk factor for atherosclerotic disease. To date, therapeutically raising HDL-C has not been shown to impact risk for cardiovascular events. Objective We aim to characterize lipid parameters at the extremes of HDL-C. Methods We examined cholesterol profiles from 1,350,908 US adults and children from the Very Large Database of Lipids who were clinically referred for advanced lipoprotein testing from 2009 to 2011. We categorized patients into HDL-C percentile categories (99th-99.9th, and >99.9th). Within these groups, we examined HDL-C subclasses, low-density lipoprotein cholesterol (LDL-C), LDL and very-low density lipoprotein densities, non-HDL-C, triglycerides (TG), very-low density lipoprotein cholesterol, and remnant lipoprotein cholesterol (RLP-C), as well as prevalence of Fredrickson-Levy dyslipidemias. Results Extremely low HDL-C percentiles were associated with increased LDL density, TG, and especially RLP-C. Very high HDL-C levels (≥92 mg/dL) showed increasing HDL2-C/HDL3-C ratio and very low levels of RLP-C and triglyceride-rich lipoproteins. Type IV dyslipidemia had the highest prevalence among classical dyslipidemia and was the most frequent at extremely low HDL-C percentiles. Conclusions These findings demonstrate a high prevalence of elevated triglyceride-rich lipoprotein levels and increased LDL density in patients with extremely low HDL-C levels. The relative contributions of these various changes in lipid profiles of patients with low HDL-C to cardiovascular risk need to be further scrutinized to more fully establish if low HDL-C is truly an independent risk factor for coronary heart disease or simply reflects detrimental shifts in the levels of atherogenic lipoproteins.

Original languageEnglish (US)
Pages (from-to)511-518
Number of pages8
JournalJournal of Clinical Lipidology
Volume9
Issue number4
DOIs
StatePublished - Jul 1 2015

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HDL Cholesterol
Databases
Phenotype
Lipids
LDL Cholesterol
VLDL Cholesterol
Lipoproteins
Dyslipidemias
Triglycerides
Coronary Disease
Cholesterol
Serum

Keywords

  • Cardiovascular diseases
  • Dyslipidemia
  • High-density lipoprotein cholesterol
  • Lipids
  • Prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Nutrition and Dietetics

Cite this

Lipid phenotypes at the extremes of high-density lipoprotein cholesterol : The very large database of lipids-9. / Quispe, Renato; Al-Hijji, Mohammed; Swiger, Kristopher; Martin, Seth; Elshazly, Mohamed B.; Blaha, Michael; Joshi, Parag H.; Blumenthal, Roger S; Sniderman, Allan D.; Toth, Peter P.; Jones, Steven.

In: Journal of Clinical Lipidology, Vol. 9, No. 4, 01.07.2015, p. 511-518.

Research output: Contribution to journalArticle

Quispe, Renato ; Al-Hijji, Mohammed ; Swiger, Kristopher ; Martin, Seth ; Elshazly, Mohamed B. ; Blaha, Michael ; Joshi, Parag H. ; Blumenthal, Roger S ; Sniderman, Allan D. ; Toth, Peter P. ; Jones, Steven. / Lipid phenotypes at the extremes of high-density lipoprotein cholesterol : The very large database of lipids-9. In: Journal of Clinical Lipidology. 2015 ; Vol. 9, No. 4. pp. 511-518.
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abstract = "Background Low serum levels of high-density lipoprotein cholesterol (HDL-C) are an important risk factor for atherosclerotic disease. To date, therapeutically raising HDL-C has not been shown to impact risk for cardiovascular events. Objective We aim to characterize lipid parameters at the extremes of HDL-C. Methods We examined cholesterol profiles from 1,350,908 US adults and children from the Very Large Database of Lipids who were clinically referred for advanced lipoprotein testing from 2009 to 2011. We categorized patients into HDL-C percentile categories (99th-99.9th, and >99.9th). Within these groups, we examined HDL-C subclasses, low-density lipoprotein cholesterol (LDL-C), LDL and very-low density lipoprotein densities, non-HDL-C, triglycerides (TG), very-low density lipoprotein cholesterol, and remnant lipoprotein cholesterol (RLP-C), as well as prevalence of Fredrickson-Levy dyslipidemias. Results Extremely low HDL-C percentiles were associated with increased LDL density, TG, and especially RLP-C. Very high HDL-C levels (≥92 mg/dL) showed increasing HDL2-C/HDL3-C ratio and very low levels of RLP-C and triglyceride-rich lipoproteins. Type IV dyslipidemia had the highest prevalence among classical dyslipidemia and was the most frequent at extremely low HDL-C percentiles. Conclusions These findings demonstrate a high prevalence of elevated triglyceride-rich lipoprotein levels and increased LDL density in patients with extremely low HDL-C levels. The relative contributions of these various changes in lipid profiles of patients with low HDL-C to cardiovascular risk need to be further scrutinized to more fully establish if low HDL-C is truly an independent risk factor for coronary heart disease or simply reflects detrimental shifts in the levels of atherogenic lipoproteins.",
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T1 - Lipid phenotypes at the extremes of high-density lipoprotein cholesterol

T2 - The very large database of lipids-9

AU - Quispe, Renato

AU - Al-Hijji, Mohammed

AU - Swiger, Kristopher

AU - Martin, Seth

AU - Elshazly, Mohamed B.

AU - Blaha, Michael

AU - Joshi, Parag H.

AU - Blumenthal, Roger S

AU - Sniderman, Allan D.

AU - Toth, Peter P.

AU - Jones, Steven

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N2 - Background Low serum levels of high-density lipoprotein cholesterol (HDL-C) are an important risk factor for atherosclerotic disease. To date, therapeutically raising HDL-C has not been shown to impact risk for cardiovascular events. Objective We aim to characterize lipid parameters at the extremes of HDL-C. Methods We examined cholesterol profiles from 1,350,908 US adults and children from the Very Large Database of Lipids who were clinically referred for advanced lipoprotein testing from 2009 to 2011. We categorized patients into HDL-C percentile categories (99th-99.9th, and >99.9th). Within these groups, we examined HDL-C subclasses, low-density lipoprotein cholesterol (LDL-C), LDL and very-low density lipoprotein densities, non-HDL-C, triglycerides (TG), very-low density lipoprotein cholesterol, and remnant lipoprotein cholesterol (RLP-C), as well as prevalence of Fredrickson-Levy dyslipidemias. Results Extremely low HDL-C percentiles were associated with increased LDL density, TG, and especially RLP-C. Very high HDL-C levels (≥92 mg/dL) showed increasing HDL2-C/HDL3-C ratio and very low levels of RLP-C and triglyceride-rich lipoproteins. Type IV dyslipidemia had the highest prevalence among classical dyslipidemia and was the most frequent at extremely low HDL-C percentiles. Conclusions These findings demonstrate a high prevalence of elevated triglyceride-rich lipoprotein levels and increased LDL density in patients with extremely low HDL-C levels. The relative contributions of these various changes in lipid profiles of patients with low HDL-C to cardiovascular risk need to be further scrutinized to more fully establish if low HDL-C is truly an independent risk factor for coronary heart disease or simply reflects detrimental shifts in the levels of atherogenic lipoproteins.

AB - Background Low serum levels of high-density lipoprotein cholesterol (HDL-C) are an important risk factor for atherosclerotic disease. To date, therapeutically raising HDL-C has not been shown to impact risk for cardiovascular events. Objective We aim to characterize lipid parameters at the extremes of HDL-C. Methods We examined cholesterol profiles from 1,350,908 US adults and children from the Very Large Database of Lipids who were clinically referred for advanced lipoprotein testing from 2009 to 2011. We categorized patients into HDL-C percentile categories (99th-99.9th, and >99.9th). Within these groups, we examined HDL-C subclasses, low-density lipoprotein cholesterol (LDL-C), LDL and very-low density lipoprotein densities, non-HDL-C, triglycerides (TG), very-low density lipoprotein cholesterol, and remnant lipoprotein cholesterol (RLP-C), as well as prevalence of Fredrickson-Levy dyslipidemias. Results Extremely low HDL-C percentiles were associated with increased LDL density, TG, and especially RLP-C. Very high HDL-C levels (≥92 mg/dL) showed increasing HDL2-C/HDL3-C ratio and very low levels of RLP-C and triglyceride-rich lipoproteins. Type IV dyslipidemia had the highest prevalence among classical dyslipidemia and was the most frequent at extremely low HDL-C percentiles. Conclusions These findings demonstrate a high prevalence of elevated triglyceride-rich lipoprotein levels and increased LDL density in patients with extremely low HDL-C levels. The relative contributions of these various changes in lipid profiles of patients with low HDL-C to cardiovascular risk need to be further scrutinized to more fully establish if low HDL-C is truly an independent risk factor for coronary heart disease or simply reflects detrimental shifts in the levels of atherogenic lipoproteins.

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KW - Dyslipidemia

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KW - Lipids

KW - Prevention

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