ABSTRACT
Dyslipidemia, including low levels of high-density lipoprotein cholesterol (HDL-C), is a relatively well-established risk factor for cardiovascular disease. However, the independent association between changes in HDL-C and the subsequent risk of cardiovascular events has not been well studied. The retrospective cohort analysis was conducted to evaluate the association between changes in HDL-C and cardiovascular (CV) and/or cerebrovascular (CB) events among statin-treated patients. Patient demo-graphics, clinical characteristics, laboratory data, and CV/CB events, were collected from the UK General Practice Research Database. The association between the risk of an incident event and changes in patients’ HDL-C was estimated using multivariate Cox pro-portional hazards models. Among 17,923 statin-treated patients with an average follow-up of 1.9 years, there were 815 CV events and 220 CB events. The average change in HDL-C experienced was 0.4 mg/dL, ranging from 11 mg/dL average decrease in the lowest change quartile to 12 mg/dL average increase in the highest change quartile. CV events occurred at an average overall rate of 21 per 1000 person-years and 17 per 1000 person-years among individuals in the highest quartile of change in HDL-C levels. Fully adjusted Cox regression estimated a 6% decrease in hazards (HR, 0.94; 95% CI, 0.90, 0.98) of a subsequent CV event associated with each 5 mg/dL increase in HDL-C. Similar results (HR: 0.95, 95% CI, 0.92, 0.98) were observed when assessing the association with changes in HDL-C and the composite outcome of CV/CB event. Among statin-treated patients from UK clinical practices, increases in HDL-C were associated with a significantly decreased relative risk of experiencing CV/CB events with a more pronounced effect on CV events. Therefore, a more aggressive treatment to increase HDL-C could benefit patients by reducing the risk of CV/CB events.