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Daily Dose: HDL Cholesterol May No Longer be So "Good"


Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On November 22, 2022, we reviewed a study published in the Journal of the American College of Cardiology that aimed to understand why coronary heart disease (CHD) risk equations underperform in Black adults.

The study

The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study recruited 30 239 Black and White adults aged over 45 years between 2003 and 2007. Researchers 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).

The results

Among the 23 901 CHD-free adults over a median 10 years of follow-up, 664 and 951 CHD events occured among Black and White participants, respectively. LDL-C and triglycerides were associated with an increased risk of CHD in both Whites and Blacks.

After adjustment for clinical risk factors, analysis showed that low HDL-C was associated with increased risk of CHD in White but not in Black adults. Results also showed that high HDL-C was no longer protective, ie, not associated with decreased CHD events, in either White or Black participants.

Clinical implications

"Although we need to gather further population-based evidence, our data support the notion that the value of high HDL-C in risk prediction algorithms should be demoted."

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