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Purpose <p>Low high-density lipoprotein cholesterol (HDL-C) levels have been associated with increased risk of coronary artery disease (CAD) in the general population. We examined the association between HDL-C levels and CAD prevalence in adult patients with heterozygous familial hypercholesterolemia (HeFH) in the HELLAS-FH registry.</p> Methods <p>Adult patients with HeFH were categorized into quartiles based on baseline (i.e., before any treatment) HDL-C levels. Patient demographics, lipid profile, CAD risk factors and CAD prevalence were analyzed.</p> Results <p>Patients (<i>n</i> = 1867; 960 males; mean age 51 ± 14 years) were divided into quartiles based on baseline HDL-C levels: Q1 (35 ± 5&#xa0;mg/dL), Q2 (45 ± 2&#xa0;mg/dL), Q3 (54 ± 3&#xa0;mg/dL) and Q4 (70 ± 10&#xa0;mg/dL). Lower HDL-C quartiles were associated with increased prevalence of CAD risk factors i.e. hypertension, type 2 diabetes (T2D), smoking and body mass index ≥ 25&#xa0;kg/m<sup>2</sup> compared with higher ones. The lowest HDL-C quartile was associated with the highest prevalence of established total (47.6%) and premature CAD (39.7%) among HeFH patients (<i>p</i> &lt; 0.01 compared with all other quartiles). Multivariate logistic regression indicated 5% lower odds of prevalent CAD for each 1&#xa0;mg/dL higher HDL-C after adjusting for major ASCVD risk factors, including triglycerides. This association of HDL-C was linear and persisted across patient subgroups based on sex, age, hypertension, smoking and T2D as well as across low-density lipoprotein cholesterol quartiles.</p> Conclusion <p>An independent inverse linear association was observed between HDL-C concentrations and CAD prevalence in patients with HeFH. These findings emphasize the importance of considering HDL-C levels in CAD risk stratification of patients with HeFH.</p>

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HDL cholesterol as an associate of prevalent coronary artery disease in heterozygous Familial hypercholesterolemia beyond LDL cholesterol

  • 期刊论文

  • 发表日期：

    2025年9月20日

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  • Christos V. Rizos,
  • Genovefa Kolovou,
  • Vana Kolovou,
  • George Liamis,
  • Ioannis Skoumas,
  • Loukianos Rallidis,
  • Anastasia Garoufi,
  • George Sfikas,
  • Athanasios Penopoulos,
  • Emmanouil Skalidis,
  • Kimon Stamatelopoulos,
  • Vasileios Kotsis,
  • Michalis Doumas,
  • Vaia Lambadiari,
  • Panagiotis Anagnostis,
  • Evgenia Mavrokefalou,
  • Amalia Boufidou,
  • Vasiliki Giannakopoulou,
  • Georgia Anastasiou,
  • Ermioni Petkou,
  • Charalambos Vlachopoulos,
  • Ioanna Dima,
  • Fakas Georgios,
  • Konstantinos A. Papathanasiou,
  • Achilleas Attilakos,
  • Charalambos Koumaras,
  • Dimitrios Agapakis,
  • Evangelos Zacharis,
  • Chrysoula Moustou,
  • Christina Antza,
  • Chrysoula Boutari,
  • Aikaterini Kountouri,
  • Eleni Mpellou,
  • Elisavet Prodromiadou,
  • Evangelos Liberopoulos

摘要

Purpose

Low high-density lipoprotein cholesterol (HDL-C) levels have been associated with increased risk of coronary artery disease (CAD) in the general population. We examined the association between HDL-C levels and CAD prevalence in adult patients with heterozygous familial hypercholesterolemia (HeFH) in the HELLAS-FH registry.

Methods

Adult patients with HeFH were categorized into quartiles based on baseline (i.e., before any treatment) HDL-C levels. Patient demographics, lipid profile, CAD risk factors and CAD prevalence were analyzed.

Results

Patients (n = 1867; 960 males; mean age 51 ± 14 years) were divided into quartiles based on baseline HDL-C levels: Q1 (35 ± 5 mg/dL), Q2 (45 ± 2 mg/dL), Q3 (54 ± 3 mg/dL) and Q4 (70 ± 10 mg/dL). Lower HDL-C quartiles were associated with increased prevalence of CAD risk factors i.e. hypertension, type 2 diabetes (T2D), smoking and body mass index ≥ 25 kg/m2 compared with higher ones. The lowest HDL-C quartile was associated with the highest prevalence of established total (47.6%) and premature CAD (39.7%) among HeFH patients (p < 0.01 compared with all other quartiles). Multivariate logistic regression indicated 5% lower odds of prevalent CAD for each 1 mg/dL higher HDL-C after adjusting for major ASCVD risk factors, including triglycerides. This association of HDL-C was linear and persisted across patient subgroups based on sex, age, hypertension, smoking and T2D as well as across low-density lipoprotein cholesterol quartiles.

Conclusion

An independent inverse linear association was observed between HDL-C concentrations and CAD prevalence in patients with HeFH. These findings emphasize the importance of considering HDL-C levels in CAD risk stratification of patients with HeFH.