Low HDL is independent predictor of progression of atherosclerosis

Levels of high-density lipoprotein (HDL) cholesterol are associated with future changes in atherosclerosis as measured by carotid intima-media thickness (CIMT), according to a new analysis of the Atherosclerosis Risk in Communities (ARIC) study.

In the ARIC population, lower baseline levels of HDL cholesterol correlated with larger increases in CIMT, said Paul Muntner, PhD, at the American College of Cardiology's 56th Annual Scientific Session.

"HDL cholesterol may be an important modifiable risk factor for the progression of subclinical atherosclerosis and may represent a potential therapeutic target for further reducing cardiovascular disease risk," said Dr. Muntner, associate professor, department of epidemiology, Tulane University, New Orleans.

ARIC is a population-based, prospective, cohort study of atherosclerosis and its risk factors in which adults aged 45 to 64 years from four U.S. communities were enrolled. Of the 15,792 participants, 12,615 had two or more CIMT measurements over the 9 years of the study. CIMT measurements were performed at baseline, after 3 years, and after 6 or 9 years of follow-up for white participants and after both 6 and 9 years of follow-up for blacks.

The multivariate-adjusted mean 5-year change in CIMT during the follow-up was calculated by the baseline HDL cholesterol level, both overall and stratified by levels of low-density (LDL) cholesterol levels (

Key results were as follows:

• Baseline HDL cholesterol level was inversely associated with mean CIMT at each study visit.
• After adjusting for multiple variables, low (
• After adjusting for LDL cholesterol and other variables, each 18-mg/dL increase in HDL cholesterol was associated with a 5-year change in CIMT of 8 microns (p

Since HDL cholesterol level is associated with CIMT across the range of LDL cholesterol levels, therapeutic strategies that target both risk factors may be appropriate, according to Dr. Muntner.