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Controlling for Apolipoprotein A-I concentrations changes the inverse direction of the relationship between high HDL-C concentration and a measure of pre-clinical atherosclerosis

Controlling for Apolipoprotein A-I concentrations changes the inverse direction of the relationship between high HDL-C concentration and a measure of pre-clinical atherosclerosis
Controlling for Apolipoprotein A-I concentrations changes the inverse direction of the relationship between high HDL-C concentration and a measure of pre-clinical atherosclerosis
BACKGROUND: The independent effect of high density lipoprotein cholesterol (HDL-C) concentration to confer cardiovascular disease protection has been questioned. We investigated whether the inverse association between HDL-C concentration and a measure of preclinical atherosclerosis was modified by other risk factors.

METHODS: Cross-sectional data were analysed from an occupational cohort of 12,031 men who had measurements of cardiovascular risk factors and a cardiac computed tomography (CT) estimation of coronary artery calcium (CAC) score, a measure of pre-clinical atherosclerosis. Logistic regression was used to describe associations between both HDL-C and Apo-A-I concentrations and their ratio as exposures, and CAC scores >0, ?20 and ?100, as outcomes.

RESULTS: 1351 (11.2%), 665 (5.5%) and 230 (1.9%) of participants had a CAC score >0, ?20 and ?100, respectively. Adjusting for age, glucose, triglyceride, LDL-C, systolic blood pressure, waist circumference, prior cerebrovascular accident, prior coronary artery disease, prior hypertension, alcohol consumption, smoking status and exercise, a negative association existed between HDL-C and CAC score. (E.g. odds ratio (OR) for top compared to bottom HDL-C quartile for CAC >0 = 0.78 [95%CI 0.64, 0.94], p = 0.01). Further adjustment for Apo A-I changed the direction of the association between HDL-C and CAC score >0 (OR for top compared to bottom quartiles 1.61 [95%CI 1.18, 2.21], p = 0.003). Sensitivity analyses showed that point estimates for ORs were very similar regardless of CAC score threshold (CAC >0, ?20 and ?100).

CONCLUSION: Controlling for Apo A-I concentrations changes the inverse direction of relationship between high HDL-C concentration and a measure of pre-clinical atherosclerosis.
HDL-C Apolipoprotein A-I Coronary artery calcium (CAC) score Atherosclerosis Cardio-metabolic risk factors Cardiovascular disease (CVD)
0021-9150
181-186
Sung, Ki-Sung
cbbabfc4-5a22-4ca6-ab26-9403cae81d3f
Wild, Sarah H.
b790195a-4aae-421b-81f7-2c18c96e6870
Byrne, Christopher D.
1370b997-cead-4229-83a7-53301ed2a43c
Sung, Ki-Sung
cbbabfc4-5a22-4ca6-ab26-9403cae81d3f
Wild, Sarah H.
b790195a-4aae-421b-81f7-2c18c96e6870
Byrne, Christopher D.
1370b997-cead-4229-83a7-53301ed2a43c

Sung, Ki-Sung, Wild, Sarah H. and Byrne, Christopher D. (2013) Controlling for Apolipoprotein A-I concentrations changes the inverse direction of the relationship between high HDL-C concentration and a measure of pre-clinical atherosclerosis. Atherosclerosis, 231 (2), 181-186. (doi:10.1016/j.atherosclerosis.2013.09.009). (PMID:24267222)

Record type: Article

Abstract

BACKGROUND: The independent effect of high density lipoprotein cholesterol (HDL-C) concentration to confer cardiovascular disease protection has been questioned. We investigated whether the inverse association between HDL-C concentration and a measure of preclinical atherosclerosis was modified by other risk factors.

METHODS: Cross-sectional data were analysed from an occupational cohort of 12,031 men who had measurements of cardiovascular risk factors and a cardiac computed tomography (CT) estimation of coronary artery calcium (CAC) score, a measure of pre-clinical atherosclerosis. Logistic regression was used to describe associations between both HDL-C and Apo-A-I concentrations and their ratio as exposures, and CAC scores >0, ?20 and ?100, as outcomes.

RESULTS: 1351 (11.2%), 665 (5.5%) and 230 (1.9%) of participants had a CAC score >0, ?20 and ?100, respectively. Adjusting for age, glucose, triglyceride, LDL-C, systolic blood pressure, waist circumference, prior cerebrovascular accident, prior coronary artery disease, prior hypertension, alcohol consumption, smoking status and exercise, a negative association existed between HDL-C and CAC score. (E.g. odds ratio (OR) for top compared to bottom HDL-C quartile for CAC >0 = 0.78 [95%CI 0.64, 0.94], p = 0.01). Further adjustment for Apo A-I changed the direction of the association between HDL-C and CAC score >0 (OR for top compared to bottom quartiles 1.61 [95%CI 1.18, 2.21], p = 0.003). Sensitivity analyses showed that point estimates for ORs were very similar regardless of CAC score threshold (CAC >0, ?20 and ?100).

CONCLUSION: Controlling for Apo A-I concentrations changes the inverse direction of relationship between high HDL-C concentration and a measure of pre-clinical atherosclerosis.

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More information

e-pub ahead of print date: 25 September 2013
Published date: December 2013
Keywords: HDL-C Apolipoprotein A-I Coronary artery calcium (CAC) score Atherosclerosis Cardio-metabolic risk factors Cardiovascular disease (CVD)
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 360772
URI: http://eprints.soton.ac.uk/id/eprint/360772
ISSN: 0021-9150
PURE UUID: b44a81f2-a1ef-4c0f-b98b-ff32bc15cf88
ORCID for Christopher D. Byrne: ORCID iD orcid.org/0000-0001-6322-7753

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Date deposited: 02 Jan 2014 12:14
Last modified: 23 Jul 2022 01:45

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Author: Ki-Sung Sung
Author: Sarah H. Wild

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