A National Institutes of Health-supported
study recently found that while low levels of HDL cholesterol predicted an
increased risk of heart attacks or related deaths for white adults – a
long-accepted association – the same was not true for Black adults. Additionally, higher HDL cholesterol levels
were not associated with reduced cardiovascular disease risk for either
group.
The team wanted to understand this
long-established link that labels HDL as the beneficial cholesterol, and if
that’s true for all ethnicities.
To do that, Pamir and her colleagues reviewed
data from 23,901 United States adults who participated in the Reasons for
Geographic and Racial Differences in Stroke Study (REGARDS). Previous studies
that shaped perceptions about “good” cholesterol levels and heart health were
conducted in the 1970s through research with a majority of white adult study
participants. For the current study, researchers were able to look at how
cholesterol levels from Black and white middle-aged adults without heart
disease who lived throughout the country overlapped with future cardiovascular
events.
Study participants enrolled in REGARDS between
2003-2007 and researchers analyzed information collected throughout a 10- to
11-year period. Black and white study participants shared similar
characteristics, such as age, cholesterol levels, and underlying risk factors
for heart disease, including having diabetes, high blood pressure, or smoking.
During this time, 664 Black adults and 951 white adults experienced a heart
attack or heart attack-related death. Adults with increased levels of LDL
cholesterol and triglycerides had modestly increased risks for cardiovascular
disease, which aligned with findings from previous research.
The REGARDS analysis was the largest U.S.
study to show that this was true for both Black and white adults, suggesting
that higher than optimal amounts of “good” cholesterol may not provide
cardiovascular benefits for either group.
The authors conclude that in addition to
supporting ongoing and future research with diverse populations to explore
these connections, the findings suggest that cardiovascular disease risk
calculators using HDL cholesterol could lead to inaccurate predictions for
Black adults.
Reference:
Zakai NA, Minnier J, Safford MM, et al.
Race-dependent association of high-density lipoprotein cholesterol levels with
incident coronary artery disease. Journal of the American College of Cardiology. 2022; doi:
10.1016/j.jacc.2022.09.027.