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LOW HIGH-DENSITY LIPOPROTEIN CHOLESTEROL AND INCIDENT CORONARY HEART DISEASE AMONG BLACKS IN THE REASONS FOR GEOGRAPHIC AND RACIAL DIFFERENCES IN STROKE (REGARDS) STUDY
1837 JACC April 5, 2016 Volume 67, Issue 13
Prevention LOW HIGH-DENSITY LIPOPROTEIN CHOLESTEROL AND INCIDENT CORONARY HEART DISEASE AMONG BLACKS IN THE REASONS FOR GEOGRAPHIC AND RACIAL DIFFERENCES IN STROKE (REGARDS) STUDY Moderated Poster Contributions Prevention Moderated Poster Theater, Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:10 a.m. Session Title: Prevention Potpourri: Spotlight Science in Preventive Cardiology Abstract Category: 33. Prevention: Clinical Presentation Number: 1131M-01 Authors: Lisandro Colantonio, Sergio Fazio, Robert Rosenson, Michael Miller, Maciej Banach, Monika Safford, Paul Muntner, Peter Toth, University of Alabama at Birmingham, Birmingham, AL, USA
Background: Low high-density lipoprotein cholesterol (HDL-C) has been associated with incident coronary heart disease (CHD) in many studies; however, most of these studies analyzed predominantly white populations. We examined the association of low HDL-C with incident CHD among black adults in a large population-based US cohort.
Methods: We analyzed data from black men and women ≥45 years of age without a history of CHD enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study from 2003 to 2007. Participants were included in the analysis if they had valid measurements of HDL-C, low-density lipoprotein cholesterol (LDL-C) and triglycerides at baseline (n=8,156). Low HDL-C was defined as HDL-C <40 mg/dL in men or <50 mg/dL in women. Incident CHD (MI or CHD death) was adjudicated through December 2012. Analyses were stratified by levels of LDL-C and triglycerides. Results: There were a total of 350 incident CHD events over a median follow-up of 6.8 years. After adjustment for age, gender and region of residence, low HDL-C was associated with higher risk for CHD only among participants with LDL-C ≥100 mg/dL and triglycerides <100 mg/dL (Table). Low HDL-C was not independently associated with incident CHD after further adjustment for risk factors regardless the levels of LDL-C and triglycerides. Conclusions: After adjustment for cardiovascular risk factors, low HDL-C was not associated with incident CHD in a large populationbased cohort of blacks.
Table. Incidence rates and hazard ratios for coronary heart disease associated with low HDL-C among blacks in the REGARDS study.
Participants, n Events, n Follow-up, person-years Incidence rate (95% CI)† Without low HDL-C With low HDL-C Hazard ratios (95% CI) Model 1 Model 2 Model 3
LDL-C <100 mg/dL and TG <100 mg/dL 1,559 68 9,518
LDL-C ≥100 mg/dL and TG <100 mg/dL 2,958 106 18,524
LDL-C <100 mg/dL and TG ≥100 mg/dL 920 51 5,657
LDL-C ≥100 mg/dL and TG ≥100 mg/dL 2,719 125 17,123
7.0 (5.1, 8.9) 7.7 (4.0, 11.3)
5.3 (4.1, 6.4) 7.6 (4.8, 10.4)
10.1 (6.4, 13.7) 7.9 (4.6, 11.3)
7.5 (5.8, 9.3) 7.0 (5.1, 8.9)
1.14 (0.66, 1.97) 0.69 (0.37, 1.30) 0.67 (0.36, 1.28)
1.63 (1.05, 2.51) 1.21 (0.71, 2.06) 1.25 (0.73, 2.17)
0.81 (0.47, 1.42) 0.64 (0.33, 1.23) 0.59 (0.30, 1.14)
1.00 (0.70, 1.43) 0.83 (0.55, 1.24) 0.86 (0.57, 1.29)
Median follow-up: 6.8 years (maximum follow-up 9.9 years). * Low HDL-C was defined as HDL-C <40 mg/dL among men and <50 mg/dL among women. † Per 1,000 person-years. Model 1 adjusts for age, gender and region of residence (i.e., stroke buckle, stroke belt, and non-belt/non-buckle). Model 2 adjusts for covariates in Model 1 plus education and income levels, alcohol consumption, physical activity, current smoking, BMI, diabetes, history of stroke, SBP, ACR, eGFR, hs-CRP, use of antihypertensive medications, use of beta-blockers, and use of lipid-lowering medications. Model 3 adjusts for covariates in Model 2 plus LDL-C and TG. ACR: albumin-to-creatinine ratio; BMI: body mass index; CI: confidence interval; eGFR: estimated glomerular filtration rate; HDL-C: high-density lipoprotein cholesterol; HR: hazard ratio; hs-CRP: high-sensitivity C-reactive protein; LDL-C: low-density lipoprotein cholesterol; REGARDS: REasons for Geographic And Racial Differences in Stroke; SBP: systolic blood pressure; TG: triglycerides.
Prevention LOW HIGH-DENSITY LIPOPROTEIN CHOLESTEROL AND INCIDENT CORONARY HEART DISEASE AMONG BLACKS IN THE REASONS FOR GEOGRAPHIC AND RACIAL DIFFERENCES IN STROKE (REGARDS) STUDY Moderated Poster Contributions Prevention Moderated Poster Theater, Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:10 a.m. Session Title: Prevention Potpourri: Spotlight Science in Preventive Cardiology Abstract Category: 33. Prevention: Clinical Presentation Number: 1131M-01 Authors: Lisandro Colantonio, Sergio Fazio, Robert Rosenson, Michael Miller, Maciej Banach, Monika Safford, Paul Muntner, Peter Toth, University of Alabama at Birmingham, Birmingham, AL, USA
Background: Low high-density lipoprotein cholesterol (HDL-C) has been associated with incident coronary heart disease (CHD) in many studies; however, most of these studies analyzed predominantly white populations. We examined the association of low HDL-C with incident CHD among black adults in a large population-based US cohort.
Methods: We analyzed data from black men and women ≥45 years of age without a history of CHD enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study from 2003 to 2007. Participants were included in the analysis if they had valid measurements of HDL-C, low-density lipoprotein cholesterol (LDL-C) and triglycerides at baseline (n=8,156). Low HDL-C was defined as HDL-C <40 mg/dL in men or <50 mg/dL in women. Incident CHD (MI or CHD death) was adjudicated through December 2012. Analyses were stratified by levels of LDL-C and triglycerides. Results: There were a total of 350 incident CHD events over a median follow-up of 6.8 years. After adjustment for age, gender and region of residence, low HDL-C was associated with higher risk for CHD only among participants with LDL-C ≥100 mg/dL and triglycerides <100 mg/dL (Table). Low HDL-C was not independently associated with incident CHD after further adjustment for risk factors regardless the levels of LDL-C and triglycerides. Conclusions: After adjustment for cardiovascular risk factors, low HDL-C was not associated with incident CHD in a large populationbased cohort of blacks.
Table. Incidence rates and hazard ratios for coronary heart disease associated with low HDL-C among blacks in the REGARDS study.
Participants, n Events, n Follow-up, person-years Incidence rate (95% CI)† Without low HDL-C With low HDL-C Hazard ratios (95% CI) Model 1 Model 2 Model 3
LDL-C <100 mg/dL and TG <100 mg/dL 1,559 68 9,518
LDL-C ≥100 mg/dL and TG <100 mg/dL 2,958 106 18,524
LDL-C <100 mg/dL and TG ≥100 mg/dL 920 51 5,657
LDL-C ≥100 mg/dL and TG ≥100 mg/dL 2,719 125 17,123
7.0 (5.1, 8.9) 7.7 (4.0, 11.3)
5.3 (4.1, 6.4) 7.6 (4.8, 10.4)
10.1 (6.4, 13.7) 7.9 (4.6, 11.3)
7.5 (5.8, 9.3) 7.0 (5.1, 8.9)
1.14 (0.66, 1.97) 0.69 (0.37, 1.30) 0.67 (0.36, 1.28)
1.63 (1.05, 2.51) 1.21 (0.71, 2.06) 1.25 (0.73, 2.17)
0.81 (0.47, 1.42) 0.64 (0.33, 1.23) 0.59 (0.30, 1.14)
1.00 (0.70, 1.43) 0.83 (0.55, 1.24) 0.86 (0.57, 1.29)
Median follow-up: 6.8 years (maximum follow-up 9.9 years). * Low HDL-C was defined as HDL-C <40 mg/dL among men and <50 mg/dL among women. † Per 1,000 person-years. Model 1 adjusts for age, gender and region of residence (i.e., stroke buckle, stroke belt, and non-belt/non-buckle). Model 2 adjusts for covariates in Model 1 plus education and income levels, alcohol consumption, physical activity, current smoking, BMI, diabetes, history of stroke, SBP, ACR, eGFR, hs-CRP, use of antihypertensive medications, use of beta-blockers, and use of lipid-lowering medications. Model 3 adjusts for covariates in Model 2 plus LDL-C and TG. ACR: albumin-to-creatinine ratio; BMI: body mass index; CI: confidence interval; eGFR: estimated glomerular filtration rate; HDL-C: high-density lipoprotein cholesterol; HR: hazard ratio; hs-CRP: high-sensitivity C-reactive protein; LDL-C: low-density lipoprotein cholesterol; REGARDS: REasons for Geographic And Racial Differences in Stroke; SBP: systolic blood pressure; TG: triglycerides.