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ABSTRACT
Objective: The objective of this study was to identify key determinants of high-density lipoprotein-cholesterol (HDL-C) level, including subclinical inflammation and insulin resistance, and to determine the prevalence of a low HDL-C phenotype in dyslipidaemic patients at high cardiovascular risk.
Methods: In a cross-sectional study, we assessed the prevalence of low HDL‐C phenotypes in 14 667 dyslipidaemic patients attending our specialised lipid clinic and evaluated the potential relationships between HDL‐C level and 16 clinical and biological parameters.
Results: In univariate analysis, women exhibited higher plasma concentrations of HDL‐C as compared with men. Levels of triglycerides, fasting blood glucose, uric acid, waist circumference, body mass index, high sensitivity C-reactive protein (hs‐CRP), insulin resistance (as HOMA‐IR index) and smoking were all negatively correlated with HDL‐C, whereas age was positively correlated with HDL‐C levels. Moderate drinkers (10–30 g/day) displayed higher HDL‐C concentrations as compared with abstinent subjects; in contrast, consumption of more than 30 g alcohol/day was associated with a further non-significant elevation of HDL‐C levels as compared to moderate drinkers. Multivariate analysis identified eight independent correlates of HDL‐C. Age, sex and TG accounted for 37% of variability in HDL‐C; modifiable factors including waist circumference, alcohol consumption and smoking, in addition to HOMA‐IR and hs‐CRP, accounted for an additional 5% of the variability in HDL‐C. Using a cut-off of 40 mg/dL (1.03 mmol/L) for men and 50 mg/dL (1.29 mmol/L) for women, 33% and 28% of men and women displayed low levels of HDL‐C.
Conclusion: Eight independent determinants of HDL‐C account for 41% of variability in HDL‐C in our dyslipidaemic population. Three of them, i.e. age, sex and degree of triglyceridaemia accounted for more than one third of such variability. The high prevalence of low HDL‐C phenotypes in dyslipidaemic patients at elevated cardiovascular risk emphasises the need for both lifestyle and pharmacological strategies of intervention to raise HDL‐C.