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J Clin Lipidol. 2018 May - Jun;12(3):674-684.e5. doi: 10.1016/j.jacl.2018.01.014. Epub 2018 Feb 8.

Association of extremely high levels of high-density lipoprotein cholesterol with cardiovascular mortality in a pooled analysis of 9 cohort studies including 43,407 individuals: The EPOCH-JAPAN study.

Author information

1
Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.
2
Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
3
Department of Public Health, Hokkaido University Graduate School of Medicine, Hokkaido, Japan.
4
Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
5
Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan.
6
Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan.
7
Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan.
8
Department of Medical Statistics, Toho University School of Medicine, Tokyo, Japan.
9
Department of Public Health, Shiga University of Medical Science, Shiga, Japan; Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan.
10
Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan. Electronic address: okamura@z6.keio.jp.

Abstract

BACKGROUND:

The effect of very high or extremely high levels of high-density lipoprotein cholesterol (HDL-C) on cardiovascular disease (CVD) is not well described. Although a few recent studies have reported the adverse effects of extremely high levels of HDL-C on CVD events, these did not show a statistically significant association between extremely high levels of HDL-C and cause-specific CVD mortality. In addition, Asian populations have not been studied.

OBJECTIVE:

We examine the impact of extremely high levels of HDL-C on cause-specific CVD mortality using pooled data of Japanese cohort studies.

METHODS:

We performed a large-scale pooled analysis of 9 Japanese cohorts including 43,407 participants aged 40-89 years, dividing the participants into 5 groups by HDL-C levels, including extremely high levels of HDL-C ≥2.33 mmol/L (≥90 mg/dL). We estimated the adjusted hazard ratio of each HDL-C category for all-cause death and cause-specific deaths compared with HDL-C 1.04-1.55 mmol/L (40-59 mg/dL) using a cohort-stratified Cox proportional hazards model.

RESULTS:

During a 12.1-year follow-up, 4995 all-cause deaths and 1280 deaths due to overall CVD were identified. Extremely high levels of HDL-C were significantly associated with increased risk of atherosclerotic CVD mortality (hazard ratio = 2.37, 95% confidence interval: 1.37-4.09 for total) and increased risk for coronary heart disease and ischemic stroke. In addition, the risk for extremely high HDL-C was more evident among current drinkers.

CONCLUSION:

We showed extremely high levels of HDL-C had an adverse effect on atherosclerotic CVD mortality in a pooled analysis of Japanese cohorts.

KEYWORDS:

Atherosclerotic cardiovascular disease; Cardiovascular disease; Epidemiology; High-density lipoprotein cholesterol; Mortality

PMID:
29506864
DOI:
10.1016/j.jacl.2018.01.014

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