High Density Lipoprotein Cholesterol and the Risk of All-Cause Mortality among U.S. Veterans

Abstract

Our results show a U-shaped relationship between HDL cholesterol and risk of all-cause mortality across all eGFR categories. The risk is modified by eGFR and cardiovascular disease.

High-density lipoprotein: quantity or quality?

“…The findings of the elegant study by Bowe et al (10) further strengthen the importance of evaluating HDL functionality and the limitations of relying solely on HDL-C levels for mortality risk prediction. Indeed, subjects with the highest HDL-C levels had increased all-cause mortality (10).…”

“…In this context, the results of a recent study by Bowe et al are clinically relevant (10). In this study, a cohort of 1,764,986 US veterans were followed for a median of 9.1 years and the association between serum HDL-C levels and all-cause mortality was analyzed.…”

“…Therefore, the association of HDL-C and all-cause mortality appeared to follow a U-shaped curve. Moreover, the reduction of all-cause mortality with increasing HDL-C levels was smaller in patients with GFR <45 mL/min/1.73 m 2 , suggesting that the presence of CKD diminishes the protective effects of HDL (10).…”

A big data approach to examine the association of high density lipoprotein cholesterol and mortality: lessons for future investigations

“…Taken together, these studies suggest that (I) the relationship between HDL-C and risk of death is not linear and; (II) HDL-C is a confounded measure and is a non-specific cardiovascular risk factor associated with noncardiovascular outcomes (6,7).…”

“…Recent Mendelian randomization analyses showed that genetic mechanisms that raise plasma HDL-C did not result in reduced risk of myocardial infarction (5). Given this background, recently Bowe et al took a big data approach to characterize the association between HDL-C and risk of death in a cohort of 1.7 million United States veterans followed for over 9 years and described-for the first time-a U-shaped association between HDL-C and risk of death in that both low and high HDL-C levels were associated with increased risk of death (6). In another study of 1.9 million United States veterans followed for 9 years, Bowe et al…”