Controlling for apolipoprotein A-I concentrations changes the inverse direction of the relationship between high HDL-C concentration and a measure of pre-clinical atherosclerosis

Ki-Chul Sung*, Sarah H. Wild, Christopher D. Byrne

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The independent effect of high density lipoprotein cholesterol (HDL-C) concentration to confer cardiovascular disease protection has been questioned. We investigated whether the inverse association between HDL-C concentration and a measure of preclinical atherosclerosis was modified by other risk factors.

Methods: Cross-sectional data were analysed from an occupational cohort of 12,031 men who had measurements of cardiovascular risk factors and a cardiac computed tomography (CT) estimation of coronary artery calcium (CAC) score, a measure of pre-clinical atherosclerosis. Logistic regression was used to describe associations between both HDL-C and Apo-A-I concentrations and their ratio as exposures, and CAC scores >0, >= 20 and >= 100, as outcomes.

Results: 1351 (11.2%), 665 (5.5%) and 230 (1.9%) of participants had a CAC score >0, >= 0 and >= 100, respectively. Adjusting for age, glucose, triglyceride, LDL-C, systolic blood pressure, waist circumference, prior cerebrovascular accident, prior coronary artery disease, prior hypertension, alcohol consumption, smoking status and exercise, a negative association existed between HDL-C and CAC score. (E.g. odds ratio (OR) for top compared to bottom HDL-C quartile for CAC >0 = 0.78 [95%CI 0.64, 0.94], p = 0.01). Further adjustment for Apo A-I changed the direction of the association between HDL-C and CAC score >0 (OR for top compared to bottom quartiles 1.61 [95%CI 1.18, 2.21], p = 0.003). Sensitivity analyses showed that point estimates for ORs were very similar regardless of CAC score threshold (CAC >0, >= 20 and >= 100).

Conclusion: Controlling for Apo A-I concentrations changes the inverse direction of relationship between high HDL-C concentration and a measure of pre-clinical atherosclerosis. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)181-186
Number of pages6
JournalAtherosclerosis
Volume231
Issue number2
DOIs
Publication statusPublished - 1 Dec 2013

Keywords

  • HDL-C
  • Apolipoprotein A-I
  • Coronary artery calcium (CAC) score
  • Atherosclerosis
  • Cardio-metabolic risk factors
  • Cardiovascular disease (CVD)
  • HIGH-DENSITY-LIPOPROTEIN
  • REVERSE CHOLESTEROL TRANSPORT
  • CORONARY-ARTERY-DISEASE
  • ESTER TRANSFER PROTEIN
  • COMPUTED-TOMOGRAPHY
  • HEART-DISEASE
  • RISK
  • PREDICTION
  • CALCIUM

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