Language
English
Publication Date
11-7-2023
Journal
Journal of the American Heart Association
DOI
10.1161/JAHA.123.031160
PMID
37929707
PMCID
PMC10727395
PubMedCentral® Posted Date
11-6-2023
PubMedCentral® Full Text Version
Post-print
Abstract
Background
High‐density lipoprotein (HDL) particle concentration likely outperforms HDL cholesterol in predicting atherosclerotic cardiovascular events. Whether size‐based HDL subspecies explain the atheroprotective associations of HDL particle concentration remains unknown. Our objective was to assess whether levels of specific size‐based HDL subspecies associate with atherosclerotic cardiovascular disease in a multiethnic pooled cohort and improve risk prediction beyond traditional atherosclerotic cardiovascular disease risk factors.
Methods and Results
Seven HDL size‐based subspecies were quantified by nuclear magnetic resonance (LP4 algorithm; H1=smallest; H7=largest) among participants without prior atherosclerotic cardiovascular disease in ARIC (Atherosclerosis Risk in Communities), MESA (Multi‐Ethnic Study of Atherosclerosis), PREVEND (Prevention of Renal and Vascular Endstage Disease), and DHS (Dallas Heart Study) cohorts (n=15 371 people). Multivariable Cox proportional hazards models were used to evaluate the association between HDL subspecies and incident myocardial infarction (MI) or ischemic stroke at follow‐up (average 8–10 years) adjusting for HDL cholesterol and risk factors. Improvement in risk prediction was assessed via discrimination and reclassification analysis. Within the pooled cohort (median age 57 years; female 54%; Black 22%) higher H1 (small) and H4 (medium) concentrations were inversely associated with incident MI (hazard ratio [HR]/SD, H1 0.88 [95% CI, 0.81–0.94]; H4 0.89 [95% CI, 0.82–0.97]). H4 but not H1 improved risk prediction indices for incident MI. Increasing H2 and H4 were inversely associated with improved risk prediction indices for composite end point of stroke, MI, and cardiovascular death (HR/SD, H2 0.94 [95% CI, 0.88–0.99]; H4 0.91 [95% CI, 0.85–0.98]). Levels of the large subspecies (H6 and H7) were not associated with any vascular end point.
Conclusions
Two of 7 HDL size‐based subspecies modestly improved risk prediction for MI and composite vascular end points in a large multiethnic pooled cohort. These findings support assessment of precise HDL subspecies for future studies regarding clinical utility.
Keywords
Humans, Female, Middle Aged, Lipoproteins, HDL, Cholesterol, HDL, Atherosclerosis, Risk Factors, Myocardial Infarction, HDL, HDL size, HDL‐C, MI, multiethnic, stroke, Biomarkers, Lipids and Cholesterol
Published Open-Access
yes
Recommended Citation
Deets, Austin; Joshi, Parag H; Chandra, Alvin; et al., "Novel Size-Based High-Density Lipoprotein Subspecies and Incident Vascular Events" (2023). Faculty and Staff Publications. 4307.
https://digitalcommons.library.tmc.edu/baylor_docs/4307