High-Density Lipoprotein Cholesterol and Cause-Specific Mortality in Individuals Without Previous Cardiovascular Conditions: The CANHEART Study

Dennis T. Ko*, David A. Alter, Helen Guo, Maria Koh, Geoffrey Lau, Peter C. Austin, Gillian L. Booth, William Hogg, Cynthia A. Jackevicius, Douglas S. Lee, Harindra C. Wijeysundera, John T. Wilkins, Jack V. Tu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

95 Scopus citations

Abstract

Background The prognostic importance of high-density lipoprotein cholesterol (HDL-C) as a specific risk factor for cardiovascular (CV) disease has been challenged by recent clinical trials and genetic studies. Objectives This study sought to reappraise the association of HDL-C level with CV and non-CV mortality using a “big data” approach. Methods An observational cohort study was conducted using the CANHEART (Cardiovascular Health in Ambulatory Care Research Team) dataset, which was created by linking together 17 different individual-level data sources. People were included if they were between 40 and 105 years old on January 1, 2008, living in Ontario, Canada, without previous CV conditions or severe comorbidities, and had an outpatient fasting cholesterol measurement in the year prior to the inception date. The primary outcome was cause-specific mortality. Results A total of 631,762 individuals were included. The mean age of our cohort was 57.2 years, 55.4% were women, and mean HDL-C level was 55.2 mg/dl. There were 17,952 deaths during a mean follow-up of 4.9 ± 0.4 years. The overall all-cause mortality rate was 8.1 per 1,000 person-years for men and 6.6 per 1,000 person-years for women. Individuals with lower HDL-C levels were more likely to have low incomes, unhealthy lifestyle, higher triglycerides levels, other cardiac risk factors, and medical comorbidities. Individuals with lower HDL-C levels were independently associated with higher risk of CV, cancer, and other mortality compared with individuals in the reference ranges of HDL-C levels. In addition, individuals with higher HDL levels (>70 mg/dl in men, >90 mg/dl in women) had increased hazard of non-CV mortality. Conclusions Complex associations exist between HDL-C levels and sociodemographic, lifestyle, comorbidity factors, and mortality. HDL-C level is unlikely to represent a CV-specific risk factor given similarities in its associations with non-CV outcomes.

Original languageEnglish (US)
Pages (from-to)2073-2083
Number of pages11
JournalJournal of the American College of Cardiology
Volume68
Issue number19
DOIs
StatePublished - Nov 8 2016

Keywords

  • cardiac and noncardiac death
  • epidemiology
  • outcomes
  • risk factor
  • sociodemographic

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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