Szatrowski Austin, Maggio Zane, Khomtchouk Bohdan
The College of the University of Chicago, Chicago, Illinois, USA.
The College of the University of Chicago, Chicago, Illinois, USA; Department of Biomedical Engineering and Informatics, Luddy School of Informatics, Indiana University, Indianapolis, Indiana, USA.
JACC Adv. 2025 May 2;4(6 Pt 1):101741. doi: 10.1016/j.jacadv.2025.101741.
High-density lipoprotein cholesterol (HDL-C) is inversely associated with cardiometabolic risk and exhibits nonlinear effects at extreme levels. Cardiometabolic diseases are a leading cause of death and are particularly prevalent among Native Hawaiian and Pacific Islanders (NHPIs).
This study characterizes HDL-C's association with coronary artery disease (CAD), major adverse cardiovascular events (MACE), and type 2 diabetes (T2D) in NHPIs compared to the general population.
Using electronic health record data from the National Institutes of Health All of Us Research Program, we applied Cox proportional hazards models to compare HDL-C's protective effects on CAD, MACE, and T2D between 261 NHPIs and the remaining cohort (n = 188,802). Models were adjusted for key confounders, and restricted cubic splines were used to assess nonlinear risk dynamics.
Tracking individuals across 10,534,661 person-years (mean age 55.7 ± 15.8 years, 38% male), HDL-C was more strongly associated with reduced CAD risk in NHPIs (HR: 0.32; 95% CI: 0.19-0.54) than in the general cohort (HR: 0.57; 95% CI: 0.56-0.58). A marginally stronger association was observed for MACE (NHPI HR: 0.40; 95% CI: 0.23-0.71 vs general HR: = 0.54; 95% CI: 0.53-0.56), while T2D associations were similar. Spline analysis indicated that low HDL-C increases risk for both CAD and T2D in NHPIs.
HDL-C's protective role against cardiometabolic diseases is more pronounced in NHPIs, particularly for CAD. These findings support further investigation into tailored clinical assessments for this population.
高密度脂蛋白胆固醇（HDL-C）与心脏代谢风险呈负相关，且在极端水平时呈现非线性效应。心脏代谢疾病是主要的死亡原因，在夏威夷原住民和太平洋岛民（NHPI）中尤为普遍。
本研究旨在描述与普通人群相比，HDL-C与NHPI人群中冠状动脉疾病（CAD）、主要不良心血管事件（MACE）和2型糖尿病（T2D）之间的关联。
利用美国国立卫生研究院“我们所有人”研究项目的电子健康记录数据，我们应用Cox比例风险模型比较了261名NHPI与其余队列（n = 188,802）中HDL-C对CAD、MACE和T2D的保护作用。模型对关键混杂因素进行了调整，并使用受限立方样条来评估非线性风险动态。
在10,534,661人年（平均年龄55.7±15.8岁，38%为男性）的随访中，与普通队列相比，HDL-C与NHPI人群中CAD风险降低的关联更强（风险比：0.32；95%置信区间：0.19 - 0.54）（普通队列风险比：0.57；95%置信区间：0.56 - 0.58）。观察到HDL-C与MACE的关联略强（NHPI风险比：0.40；95%置信区间：0.23 - 0.71，普通人群风险比：0.54；95%置信区间：0.53 - 0.56），而与T2D的关联相似。样条分析表明，低HDL-C会增加NHPI人群患CAD和T2D的风险。
HDL-C对心脏代谢疾病的保护作用在NHPI人群中更为明显，尤其是对CAD。这些发现支持对该人群进行针对性临床评估的进一步研究。
