Faculty of Medicine, Federal University of Sao Joao del-Rei, Centro Oeste Campus, Divinopolis, Brazil (Dr Mamede).
Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (Dr Braga).
J Clin Lipidol. 2024 Sep-Oct;18(5):e701-e709. doi: 10.1016/j.jacl.2024.06.002. Epub 2024 Jun 12.
Recent research has raised questions about the assumed cardiovascular (CV) benefits of high-density lipoprotein cholesterol (HDL-C) and the potential for adverse outcomes with extremely high levels.
We conducted a meta-analysis to investigate the association between very high HDL-C levels (≥80 mg/dL) and mortality outcomes in individuals without coronary artery disease (CAD).
We systematically searched PubMed, Embase, and Cochrane databases for studies comparing very high HDL-C levels to normal levels (40-60 mg/dL) in CAD-free individuals. We assessed heterogeneity using I statistics with a random-effects model.
Our analysis included 1,004,584 individuals from 8 studies, of whom 133,646 (13.3%) had very high HDL-C levels. All-cause mortality did not significantly differ between groups (p = 0.55), nor did cancer mortality (p = 0.45). Cardiovascular mortality showed no change in those with very high HDL-C (hazard ratio [HR] 1.05; 95% confidence interval [CI] 0.94-1.17; p = 0.37). Fatal and non-fatal coronary heart disease events were less frequent in the very high HDL-C group (HR 0.79; 95% CI 0.73-0.86; p < 0.00001). Subgroup dose-response analysis revealed that very high HDL-C levels increased cardiovascular death in women above 116 mg/dL (HR 1.47; 95% CI 1.01-2.15) and in men above 94 mg/dL (HR 1.29; 95% CI 1.01-1.65) (p_nonlinearity <0.01).
These findings suggest that very high HDL-C levels are not protective against CV mortality and may, in fact, increase CV mortality risk especially in men.
最近的研究对高密度脂蛋白胆固醇（HDL-C）的假定心血管（CV）益处提出了质疑，并对极高水平的潜在不良后果提出了质疑。
我们进行了一项荟萃分析，以研究无冠心病（CAD）个体中极高 HDL-C 水平（≥80mg/dL）与死亡率结局之间的关系。
我们系统地检索了 PubMed、Embase 和 Cochrane 数据库，以比较 CAD 患者中极高 HDL-C 水平（≥80mg/dL）与正常水平（40-60mg/dL）的研究。我们使用随机效应模型评估了 I 统计量的异质性。
我们的分析包括来自 8 项研究的 1004584 名个体，其中 133646 名（13.3%）个体的 HDL-C 水平极高。两组之间的全因死亡率没有显著差异（p=0.55），癌症死亡率也没有差异（p=0.45）。极高 HDL-C 组的心血管死亡率没有变化（危险比[HR]1.05；95%置信区间[CI]0.94-1.17；p=0.37）。极高 HDL-C 组的致死性和非致死性冠心病事件较少（HR0.79；95%CI0.73-0.86；p<0.00001）。亚组剂量反应分析表明，极高 HDL-C 水平使女性的心血管死亡风险增加（HR1.47；95%CI1.01-2.15），使男性的心血管死亡风险增加（HR1.29；95%CI1.01-1.65）（p_非线性<0.01）。
这些发现表明，极高的 HDL-C 水平不能预防 CV 死亡率，实际上可能会增加 CV 死亡率风险，尤其是男性。
