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High-density lipoprotein subclass measurements improve mortality risk prediction, discrimination and reclassification in a cardiac catheterization cohort.

Publication ,  Journal Article
McGarrah, RW; Craig, DM; Haynes, C; Dowdy, ZE; Shah, SH; Kraus, WE
Published in: Atherosclerosis
March 2016

BACKGROUND AND AIMS: Recent failures of HDL cholesterol (HDL-C)-raising therapies to prevent cardiovascular disease (CVD) events have tempered the interest in the role of HDL-C in clinical risk assessment. Emerging data suggest that the atheroprotective properties of HDL depend on specific HDL particle characteristics not reflected by HDL-C. The purpose of this study was to determine the association of HDL particle concentration (HDL-P) and HDL subclasses with mortality in a high-risk cardiovascular population and to examine the clinical utility of these parameters in mortality risk discrimination and reclassification models. METHODS: Using nuclear magnetic resonance spectroscopy, we measured HDL-P and HDL subclasses in 3972 individuals enrolled in the CATHGEN coronary catheterization biorepository; tested for association with all-cause mortality in robust clinical models; and examined the utility of HDL subclasses in incremental mortality risk discrimination and reclassification. RESULTS: Over an average follow-up of eight years, 29.6% of the individuals died. In a multivariable model adjusted for ten CVD risk factors, HDL-P [HR, 0.71 (0.67-0.76), p = 1.3e-24] had a stronger inverse association with mortality than did HDL-C [HR 0.93 (0.87-0.99), p = 0.02]. Larger HDL size conferred greater risk and the sum of medium- and small-size HDL particles (MS-HDL-P) conferred less risk. Furthermore, the strong inverse relation of HDL-P levels with mortality was accounted for entirely by MS-HDL-P; HDL-C was not associated with mortality after adjustment for MS-HDL-P. Addition of MS-HDL-P to the GRACE Risk Score significantly improved risk discrimination and risk reclassification. CONCLUSION: HDL-P and smaller HDL subclasses were independent markers of residual mortality risk and incremental to HDL-C in a high-risk CVD population. These measures should be considered in risk stratification and future development of HDL-targeted therapies in high-risk populations.

Duke Scholars

Published In

Atherosclerosis

DOI

EISSN

1879-1484

Publication Date

March 2016

Volume

246

Start / End Page

229 / 235

Location

Ireland

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Proportional Hazards Models
  • Prognosis
  • Predictive Value of Tests
  • Nuclear Magnetic Resonance, Biomolecular
  • Multivariate Analysis
  • Middle Aged
  • Male
 

Citation

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McGarrah, R. W., Craig, D. M., Haynes, C., Dowdy, Z. E., Shah, S. H., & Kraus, W. E. (2016). High-density lipoprotein subclass measurements improve mortality risk prediction, discrimination and reclassification in a cardiac catheterization cohort. Atherosclerosis, 246, 229–235. https://doi.org/10.1016/j.atherosclerosis.2016.01.012
McGarrah, Robert W., Damian M. Craig, Carol Haynes, Z Elaine Dowdy, Svati H. Shah, and William E. Kraus. “High-density lipoprotein subclass measurements improve mortality risk prediction, discrimination and reclassification in a cardiac catheterization cohort.Atherosclerosis 246 (March 2016): 229–35. https://doi.org/10.1016/j.atherosclerosis.2016.01.012.
McGarrah, Robert W., et al. “High-density lipoprotein subclass measurements improve mortality risk prediction, discrimination and reclassification in a cardiac catheterization cohort.Atherosclerosis, vol. 246, Mar. 2016, pp. 229–35. Pubmed, doi:10.1016/j.atherosclerosis.2016.01.012.
McGarrah RW, Craig DM, Haynes C, Dowdy ZE, Shah SH, Kraus WE. High-density lipoprotein subclass measurements improve mortality risk prediction, discrimination and reclassification in a cardiac catheterization cohort. Atherosclerosis. 2016 Mar;246:229–235.
Journal cover image

Published In

Atherosclerosis

DOI

EISSN

1879-1484

Publication Date

March 2016

Volume

246

Start / End Page

229 / 235

Location

Ireland

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Proportional Hazards Models
  • Prognosis
  • Predictive Value of Tests
  • Nuclear Magnetic Resonance, Biomolecular
  • Multivariate Analysis
  • Middle Aged
  • Male