Isolated low levels of high-density lipoprotein cholesterol are associated with an increased risk of coronary heart disease: an individual participant data meta-analysis of 23 studies in the Asia-Pacific region

Huxley RRB, F.; Lam, T. H.; Czernichow, S.; Fang, X.; Welborn, T.; Shaw, J.; Ueshima, H.; Zimmet, P.; Jee, S. H.; Patel, J. V.; Caterson, I.; Perkovic, V.; Woodward, M. (2011) Isolated low levels of high-density lipoprotein cholesterol are associated with an increased risk of coronary heart disease: an individual participant data meta-analysis of 23 studies in the Asia-Pacific region. Circulation 124:2056-2064

BACKGROUND: Previous studies have suggested that there is a novel dyslipidemic profile consisting of isolated low high-density lipoprotein cholesterol (HDL-C) level that is associated with increased risk of coronary heart disease, and that this trait may be especially prevalent in Asian populations. METHODS AND RESULTS: Individual participant data from 220 060 participants (87% Asian) in 37 studies from the Asia-Pacific region were included. Low HDL-C (HDL <1.03 mmol/l="" in="" men="" and=""><1.30 mmol/l="" in="" women)="" was="" seen="" among="" 33.1%="" (95%="" confidence="" interval="" [ci],="" 32.9-33.3)="" of="" asians="" versus="" 27.0%="" (95%="" ci,="" 26.5-27.5)="" of="" non-asians=""><0.001). the="" prevalence="" of="" low="" hdl-c="" in="" the="" absence="" of="" other="" lipid="" abnormalities="" (isolated="" low="" hdl-c)="" was="" higher="" in="" asians="" compared="" with="" non-asians:="" 22.4%="" (95%="" ci,="" 22.2-22.5)="" versus="" 14.5%="" (95%="" ci,="" 14.1-14.9),="" respectively=""><0.001). during="" 6.8="" years="" of="" follow-up,="" there="" were="" 574="" coronary="" heart="" disease="" and="" 739="" stroke="" events.="" there="" was="" an="" inverse="" relationship="" between="" low="" hdl-c="" with="" coronary="" heart="" disease="" in="" all="" individuals="" (hazard="" ratio,="" 1.57;="" 95%="" ci,="" 1.31-1.87).="" in="" asians,="" isolated="" low="" levels="" of="" hdl-c="" were="" as="" strongly="" associated="" with="" coronary="" heart="" disease="" risk="" as="" low="" levels="" of="" hdl-c="" combined="" with="" other="" lipid="" abnormalities="" (hazard="" ratio,="" 1.67="" [95%="" ci,="" 1.27-2.19]="" versus="" 1.63="" [95%="" ci,="" 1.24-2.15],="" respectively).="" there="" was="" no="" association="" between="" low="" hdl-c="" and="" stroke="" risk="" in="" this="" population="" (hazard="" ratio,="" 0.95="" [95%="" ci,="" 0.78="" to="" 1.17]="" with="" nonisolated="" low="" hdl-c="" and="" 0.81="" [95%="" ci,="" 0.67-1.00]="" with="" isolated="" low="" hdl-c).="" conclusion:="" isolated="" low="" hdl-c="" is="" a="" novel="" lipid="" phenotype="" that="" appears="" to="" be="" more="" prevalent="" among="" asian="" populations,="" in="" whom="" it="" is="" associated="" with="" increased="" coronary="" risk.="" further="" investigation="" into="" this="" type="" of="" dyslipidemia="" is="">