A new study on HDL – ‘good cholesterol’ – that takes race into account, is producing some nuanced conclusions on their protective benefits for heart disease. In an article in the Journal of the American College of Cardiology titled Race-Dependent Association of High-Density Lipoprotein Cholesterol Levels With Incident Coronary Artery Disease, it looks at the risk factors of plasma lipids as they pertain to race.
The study set out to understand why coronary heart disease (CHD) risk equations under perform in black adults. Coronary heart disease remains a leading cause of death in the US and accounted for around 13% of all deaths in 2017. Black Americans have a lower risk overall of CHD, but die more often of heart disease compared to Whites, but little was known as to why this was.
Between 2003 and 2007, a cohort assembled for a study on the geographic and racial differences of strokes recruited 30,239 Black and White individuals aged ≥45 years in the US. This study analysed that group to estimate the race-specific hazard of plasma lipid levels as they related to heart attacks and death from coronary heart disease.
It found that 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. As a consequence, current high-density lipoprotein cholesterol–based risk calculations could lead to inaccurate risk assessments in Black adults. This has implications for treatment, as risk assessment models, developed primarily in cohorts of White Europeans, may misclassify risk in Black adults, potentially hindering optimal cardiovascular disease prevention and management programs for this group.
A key finding was that low high-density lipoprotein cholesterol (HDL-C) levels were detrimental only in White adults and high HDL-C levels were not protective in either race.
Coronary heart disease remains a leading cause of death in the US and accounted for around 13% of all deaths in 2017. Black Americans have a lower risk overall of CHD, but die more often of heart disease compared to Whites. You can read the study by clicking on the button below, but there is also additional insight to be gained from an editorial at JACC on the role of so-called good cholesterol in which they ask – is this a benefit or barrier to achieving health equity.
Click on the button for the study.