Time dependent changes in high density lipoprotein cholesterol and cardiovascular risk

Assi Milwidsky, Shaye Kivity, Eran Kopel, Robert Klempfner, Anat Berkovitch, Shlomo Segev, Yechezkel Sidi, Ilan Goldenberg, Elad Maor

Research output: Contribution to journalArticlepeer-review


Background High-density lipoprotein cholesterol (HDL-C) is a strong inverse predictor of cardiovascular events. The aim of the current study was to evaluate the correlation between changes in HDL-C and subsequent cardiovascular events. Methods Study population comprised 13,037 subjects free of cardiovascular disease with a mean follow up of 6 ± 3 years. Low HDL-C was defined as < 40 mg/dl for men and < 50 mg/dl for women. Participants were divided into three groups based on HDL-C levels at the first and second baseline visits: persistently-low HDL-C (LL); persistently-high HDL-C (HH); and those with high HDL-C in a one visit only: intermittently high HDL-C (LH/HL). The primary endpoint was the first occurrence of a cardiovascular event. Results A total of 529 (4.1%) incident events occurred during follow-up. HDL-C levels increased significantly between the two landmark visits (47.5 ± 12.6 vs. 48.1 ± 12.2, p < 0.001). Kaplan-Meier survival analysis showed that the cumulative probability of cardiovascular events at 6 years was highest among subjects in the LL group (7.6%), and similar among LH/HL and HH groups (3.3% and 4%, respectively; log-rank p = 0.001). Multivariate Cox regression analysis, with HDL-C as time-dependent covariate, showed that subjects with persistently low HDL-C during follow up experienced a 51% increased cardiovascular risk compared with subjects with persistently high HDL-C (p = 0.026). Subjects with intermittently high HDL-C during follow up experienced similar risk to those with persistently high HDL-C (HR = 1.02; p = 0.89). Conclusions Variations in HDL-C levels during follow-up are associated with subsequent cardiovascular risk. Patients who retain low HDL-C levels are at the cardiovascular highest risk.

Original languageEnglish
Pages (from-to)295-299
Number of pages5
JournalInternational Journal of Cardiology
Issue number2
StatePublished - 1 May 2014
Externally publishedYes


  • Cardiovascular risk
  • HDL cholesterol
  • Time dependent changes


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