Correlates of high HDL cholesterol among women with coronary heart disease

• Published in: The American heart journal Vol. 139; no. 2; pp. 288 - 296
• Main Authors: Bittner, Vera, Simon, Joel A, Fong, Josephine, Blumenthal, Roger S, Newby, Kristin, Stefanick, Marcia L
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-02-2000; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Cholesterol, HDL - blood; Coronary Disease - blood; Coronary heart disease; Double-Blind Method; Estrogen Replacement Therapy; Female; Heart; Humans; Logistic Models; Medical sciences; Middle Aged; Postmenopause; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Human; Cardiovascular disease; Cholesterol HDL; Coronary heart disease; Risk factor
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/S0002-8703(00)90238-2

Background The National Cholesterol Education Program (NCEP) has designated high-density lipoprotein cholesterol (HDL-C) ≥60 mg/dL a “negative” coronary heart disease (CHD) risk factor, but a substantial proportion of coronary events occur among women despite high HDL-C levels.
Methods and Results The objective of this study was to characterize postmenopausal women with prevalent CHD despite HDL-C ≥60 mg/dL and to identify factors that may attenuate the protective effect of high HDL-C. We analyzed baseline data from a randomized, double-blind study of estrogen/progestin replacement therapy in 2763 postmenopausal women <80 years old with CHD. Demographics, CHD risk factors, medications, anthropometrics, and lipid levels were compared among women with low, normal, and high HDL-C by NCEP criteria with and without stratification by use of lipid-lowering medications. Independent correlates of high HDL-C were determined by logistic regression analysis. HDL-C ≥60 mg/dL was present in 20% of participants. Women with high HDL-C were older, better educated, had fewer CHD risk factors, lower triglyceride levels and total cholesterol/HDL-C ratio, and were more likely to report past estrogen and current calcium antagonist, niacin, and statin use. β-Blocker, diuretic, and fibrate use was less common. Older age, alcohol consumption, niacin, and calcium antagonist use and prior estrogen use were independently associated with high HDL-C, whereas waist-to-hip ratio, smoking, triglyceride level, and β-blocker and fibrate use were inversely associated (all
P < .05).
Conclusions High HDL-C, as defined by the NCEP, occurred in 20% of women with CHD in this cohort without a concomitantly higher prevalence of other CHD risk factors. Redefinition of “high” HDL-C levels for women may be warranted.