Association between extremely high-density lipoprotein cholesterol and adverse cardiovascular outcomes: a systematic review and meta-analysis

Guanwei Zhang; Jiajuan Guo; Hongguang Jin; Xiaojing Wei; Xing Zhu; Weitao Jia; Yongsheng Huang

doi:10.3389/fcvm.2023.1201107

Association between extremely high-density lipoprotein cholesterol and adverse cardiovascular outcomes: a systematic review and meta-analysis

Front Cardiovasc Med. 2023 Jun 27:10:1201107. doi: 10.3389/fcvm.2023.1201107. eCollection 2023.

Authors

Guanwei Zhang¹, Jiajuan Guo², Hongguang Jin², Xiaojing Wei³, Xing Zhu², Weitao Jia⁴, Yongsheng Huang²

Affiliations

¹ College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China.
² Department of Cardiology, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China.
³ Department of Geriatrics, Henan Provincial Veteran Cadres Rehabilitation Hospital, Zhengzhou, China.
⁴ Department of Internal Medicine, Longkou Traditional Chinese Medicine Hospital, Yantai, China.

Abstract

Background: The association between high-density lipoprotein cholesterol (HDL-C) and adverse cardiovascular outcomes is understudied. Based on cohort studies, the current study aimed to investigate the association of extremely high HDL-C with all-cause, atherosclerotic cardiovascular disease (CVD) mortality, and stroke risk.

Methods: A systematic literature search in Embase, PubMed, Cochrane Library, and Web of Science was performed to collect relevant cohort studies published before August 20, 2022. A random-effects model was used to pool relative risks (RRs) and 95% confidence intervals (CIs).

Results: A total of 17 cohort studies involving 19,630,829 participants were included, encompassing 18,547,132 total deaths (1,328,036 CVD deaths). All-cause mortality, CVD mortality, and stroke risk in the extremely high HDL-C group were increased by 15% (RR = 1.15, 95% CI:1.05-1.25), 14% (RR = 1.14, 95% CI:0.96-1.35) and 14% (RR = 1.14, 95% CI:0.82-1.58), compared to the normal HDL-C group. In subgroup analyses, extremely high HDL-C was associated with a reduced risk of CVD mortality in women and a lower risk of stroke in men compared to normal HDL-C levels.

Conclusions: The extremely high levels of HDL-C were associated with elevated risks of all-cause mortality, CVD mortality, and stroke. More well-designed studies are needed to confirm our findings.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=370201, identifier: CRD42022370201.

Keywords: adverse cardiovascular outcomes; cohort studies; high-density lipoprotein cholesterol; meta-analysis; the extremely high level.

Publication types

Review

Grants and funding

This work was funded by the project of Department of Science and Technology of JiLin Province, grant number 20200403102SF; and the Administration of Traditional Chinese Medicine of JiLin Province, grant number 2020094.