Race-Dependent Association of High-Density Lipoprotein Cholesterol Levels With Incident Coronary Artery Disease
Key result
Low HDL-C predicts ~22% higher CHD risk in White adults only, and high HDL-C lacks protection.
- HR 1.22 (White) / HR 0.94 (Black)
- 95% CI 1.05-1.43 (White) / 0.78-1.14 (Black)
- P=0.08
- n=23,901
Why the study?
The study aimed to understand why coronary heart disease risk equations underperform in Black adults.
Does the association of HDL-C levels with incident CHD differ between Black and White adults?
Population
23,901 CHD-free Black and White adults aged >=45 years
Comparison
Plasma lipid levels compared across Black and White adults
Design
Prospective cohort study
Follow-up
Median 10 years
Authors
Discussion
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Implication
Low HDL-C raises CHD risk in Whites but not Blacks; challenges race-uniform HDL-C thresholds and leaves open race-specific validation.
Key Points
- This study aims to investigate the race-specific relationships between plasma lipid levels and coronary heart disease risk.
- Cohort recruited 30,239 Black and White individuals aged ≥45 from 2003 to 2007.
- Used Cox regression models to estimate hazard ratios for lipids and incident coronary heart disease.
- Followed 23,901 participants for a median of 10 years, tracking CHD events.
- Low HDL-C increased CHD risk in White adults (HR: 1.22; 95% CI: 1.05-1.43) but not in Black adults (HR: 0.94; 95% CI: 0.78-1.14).
- High HDL-C was not protective against CHD events in either race (HR: 0.96; 95% CI: 0.79-1.16 for White, HR: 0.91; 95% CI: 0.74-1.12 for Black).
- Low-density lipoprotein cholesterol and triglycerides modestly predicted CHD risk in both races.
Study Design
Type
Cohort (n=23,901)
Multicenter
Yes
Structured PICO
Does the association of HDL-C levels with incident CHD differ between Black and White adults?
P
Population
23,901 CHD-free Black and White adults aged ≥45 years from the contiguous United States, mean age 64 ± 9 years, 58.4% women, 57.8% White.
I
Intervention
Plasma lipid levels (HDL-C, LDL-C, triglycerides)
O
Outcome
Incident CHD (myocardial infarction or CHD death)hard clinical
Main Result
Effect estimate: HR 1.22 (White) / HR 0.94 (Black) (95% CI 1.05-1.43 (White) / 0.78-1.14 (Black))
p-value: p=0.08
Low HDL-C is associated with increased CHD risk in White but not Black adults, suggesting current HDL-C-based risk calculators may be inaccurate for Black patients.
Cite This Study
Zakai et al. (2022) conducted a cohort in Coronary heart disease (n=23,901). Plasma lipid levels (HDL-C) vs. Normal HDL-C was evaluated on Incident CHD (myocardial infarction or CHD death) (HR 1.22 (White) / HR 0.94 (Black), 95% CI 1.05-1.43 (White) / 0.78-1.14 (Black), p=0.08). Low HDL-C increased incident CHD risk in White adults (HR 1.22; 95% CI 1.05-1.43) but not Black adults (HR 0.94; 95% CI 0.78-1.14), and high HDL-C was not protective in either group.