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Sex-Specific U-Shaped Relationships Between High-Density Lipoprotein Cholesterol Levels and 10-year Major Adverse Cardiovascular Events: A Nationwide Cohort Study of 5.7 Million South Koreans
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Type
Academic journal
Author
Yang Hyun Suk (Department of Cardiovascular Medicine Research Institute of Medical Science Konkuk University Schoo) Jeong Ho Jin (Department of Preventive Medicine Research Institute of Medical Science Konkuk University School of) Kim Hyeongsu (Department of Preventive Medicine Research Institute of Medical Science Konkuk University School of)
Journal
대한진단검사의학회 Annals of Laboratory Medicine Annals of Laboratory Medicine 제42권 제4호 KCI Accredited Journals
Published
2022.7
Pages
415 - 427 (13page)
DOI
10.3343/alm.2022.42.4.415

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Sex-Specific U-Shaped Relationships Between High-Density Lipoprotein Cholesterol Levels and 10-year Major Adverse Cardiovascular Events: A Nationwide Cohort Study of 5.7 Million South Koreans
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Background: High-density lipoprotein cholesterol (HDL-C) is a well-known predictor of atherosclerotic cardiovascular diseases (ASCVD). We explored the relationships between HDL-C levels and 10-year major adverse cardiovascular events (MACE) and provided sex-specific upper reference limits for HDL-C levels. Methods: Based on the Korean National Health Insurance Sharing Service, we identified 5,703,897 subjects (women, 48%) with age ≥40 years, eligible HDL-C results, and no prior ASCVD in 2009. We investigated the distribution of 10-year MACE according to HDL-C levels in 10 mg/dL (0.26 mmol/L) intervals and in three HDL-C groups (low: men <40 mg/dL [1.03 mmol/L], women <50 mg/dL [1.29 mmol/L]; high: between low and extremely high levels; and extremely high: >90 mg/dL [2.33 mmol/L]). Results: There were U-shaped relationships between HDL-C levels and 10-year MACE with later inflection in women than in men (nadir: 80-99 mg/dL [2.07-2.56 mmol/L] and 50-59 mg/dL [1.29-1.53 mmol/L], respectively). In men, the extremely high HDL-C group showed significantly higher 10-year MACE than the high group (28.1% vs. 24.6%, P< 0.0001). In women, the extremely high group showed the lowest 10-year MACE; if the extremely high starting point was raised to 130 mg/dL, it became similar to that in men and showed higher 10-year MACE than the high group (25.6% vs. 20.1%, P<0.0001). Conclusions: The 10-year MACE showed U-shaped relationships with HDL-C levels, and extremely high HDL-C level at 90 mg/dL (2.33 mmol/L) in men was corresponding in risk to 130 mg/dL (3.36 mmol/L) in women.

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