High-density lipoprotein subclass measurements improve mortality risk prediction, discrimination and reclassification in a cardiac catheterization cohort

Atherosclerosis
Robert W McGarrahWilliam E Kraus

Abstract

Recent failures of HDL cholesterol (HDL-C)-raising therapies to prevent cardiovascular disease (CVD) events have tempered the interest in the role of HDL-C in clinical risk assessment. Emerging data suggest that the atheroprotective properties of HDL depend on specific HDL particle characteristics not reflected by HDL-C. The purpose of this study was to determine the association of HDL particle concentration (HDL-P) and HDL subclasses with mortality in a high-risk cardiovascular population and to examine the clinical utility of these parameters in mortality risk discrimination and reclassification models. Using nuclear magnetic resonance spectroscopy, we measured HDL-P and HDL subclasses in 3972 individuals enrolled in the CATHGEN coronary catheterization biorepository; tested for association with all-cause mortality in robust clinical models; and examined the utility of HDL subclasses in incremental mortality risk discrimination and reclassification. Over an average follow-up of eight years, 29.6% of the individuals died. In a multivariable model adjusted for ten CVD risk factors, HDL-P [HR, 0.71 (0.67-0.76), p = 1.3e-24] had a stronger inverse association with mortality than did HDL-C [HR 0.93 (0.87-0.99), p = 0.02]. Larger H...Continue Reading

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Citations

Jul 12, 2016·Atherosclerosis·Robert W McGarrah
May 16, 2017·Current Opinion in Lipidology·Laurent O MartinezBertrand Perret
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Jan 13, 2018·Lipids in Health and Disease·Päivi HämäläinenMauno Vanhala
Dec 9, 2020·Scientific Reports·Stephen EllisonSvati H Shah
Jul 9, 2021·Clinical Nutrition : Official Journal of the European Society of Parenteral and Enteral Nutrition·Seán R MillarCatherine M Phillips

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