Association of Lipid Subfractions and Cardiovascular Events in Women

An analysis confirms the inverse relation between HDL cholesterol levels and adverse coronary events in women.


Atherogenic lipoproteins include very-low-density, low-density, and intermediate-density particles, each of which carries an apolipoprotein B molecule. High-density lipoprotein cholesterol (HDL-C) particles carry apolipoprotein A-I. Prior studies have established the presence of an inverse relation between HDL-C levels and adverse cardiovascular outcomes; however, the association has not been fully studied in women across the full range of low-density lipoprotein (LDL-C) levels. In this analysis from the Women's Health Study, researchers evaluated the relation between differing lipoprotein subfractions and incident adverse cardiovascular outcomes.

The 27,000 participants were followed for a mean of 11 years. After adjustment for multiple known coronary risk factors, the following associations were noted:

•     HDL-C level was inversely associated with adverse coronary events (e.g., twofold higher risk with HDL-C level 62 mg/dL), regardless of LDL-C level.

•     Similar but weaker inverse associations were found for apolipoprotein A-I level.

•     No association was found between HDL-C or apolipoprotein A-I levels and stroke risk.

•     Adverse coronary event rates started to plateau as HDL-C levels exceeded 57 mg/dL. Women with HDL-C levels >70 mg/dL were not immune to adverse coronary events, but events tended to occur 10 years later.

•     Among women with low total atherogenic particle burden (apolipoprotein B level <0.90 g/L), few adverse cardiovascular events and no interaction with HDL-C levels occurred.

Citation(s):

Mora S et al. Association of high-density lipoprotein cholesterol with incident cardiovascular events in women, by low-density lipoprotein cholesterol and apolipoprotein B100 levels: A cohort study. Ann Intern Med 2011 Dec 6; 155:742.