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.
Cohort (n=23,901)
Yes
Does the association of HDL-C levels with incident CHD differ between Black and White adults?
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.
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
BACKGROUND: Plasma lipids are risk factors for coronary heart disease (CHD) in part because of race-specific associations of lipids with CHD. OBJECTIVES: The purpose of this study was to understand why CHD risk equations underperform in Black adults. METHODS: Between 2003 and 2007, the REGARDS (REasons for Geographic and Racial Differences in Stroke) cohort recruited 30,239 Black and White individuals aged ≥45 years from the contiguous United States. We used Cox regression models adjusted for clinical and behavioral risk factors to estimate the race-specific hazard of plasma lipid levels with incident CHD (myocardial infarction or CHD death). RESULTS: Among 23,901 CHD-free participants (57.8% White and 58.4% women, mean age 64 ± 9 years) over a median 10 years of follow-up, 664 and 951 CHD events occurred among Black and White adults, respectively. Low-density lipoprotein cholesterol and triglycerides were associated with increased risk of CHD in both races (P interaction by race >0.10). For sex-specific clinical HDL-C categories: low HDL-C was associated with increased CHD risk in White (HR: 1.22; 95% CI: 1.05-1.43) but not in Black (HR: 0.94; 95% CI: 0.78-1.14) adults (P interaction by race = 0.08); high HDL-C was not associated with decreased CHD events in either race (HR: 0.96; 95% CI: 0.79-1.16 for White participants and HR: 0.91; 95% CI: 0.74-1.12 for Black adults). CONCLUSIONS: Low-density lipoprotein cholesterol and triglycerides modestly predicted CHD risk in Black and White adults. Low HDL-C was associated with increased CHD risk in White but not Black adults, and high HDL-C was not protective in either group. Current high-density lipoprotein cholesterol-based risk calculations could lead to inaccurate risk assessment in Black adults.
Zakai et al. (Tue,) 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.
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