Associations of high-density lipoprotein cholesterol levels with the presence and severity of coronary atherosclerosis

BACKGROUND AND AIMS: Emerging evidence suggest a controversial relationship between high-density lipoprotein cholesterol (HDL-C) and adverse cardiovascular outcomes. We aimed to explore the associations of serum HDL-C levels with the presence and severity of coronary artery disease (CAD) in patients who underwent coronary angiography using a real-life clinical database. METHODS: We utilized the Cholesterol and Angiography (Chol-Angio) Registry, which comprised data on 3057 cardiac patients who had undergone invasive diagnostic and interventional procedures. Multivariable linear regression models were employed to examine the relationships between serum HDL-C and the presence and extent of coronary atherosclerosis, with stratification by statin usage. RESULTS: Significant stenosis (70-100 % stenosis degree) was most prevalent in the proximal segments of the major coronary arteries, affecting 49.4 % of all documented findings (0-100 % stenosis degree). Serum HDL-C levels were inversely associated with the presence of coronary atherosclerosis, across different segments of the coronary arteries: Betas (95 % CI) of -0.0584 (-0.0871, -0.0297) and -0.0579 (-0.0866, -0.0291) for left main or proximal left ascending coronary artery without and with adjustment for statin use, respectively. There was an inverse dose-response relationship between of HDL-C levels and severity of coronary atherosclerosis in both statin users and non-statin users. However, the extent of coronary atherosclerosis was lower among non-statin users across all serum HDL-C levels. CONCLUSIONS: In patients undergoing coronary angiography, serum HDL-C levels are inversely associated with the presence and the severity of coronary atherosclerosis. The inverse association between serum HDL-C levels and the severity of coronary atherosclerosis is not modified by statins use and is consistent with a dose-response relationship.