Associations of HDL metrics with coronary artery calcium score and density among women traversing menopause

Clinical characterization and detection of subclinical atherosclerosis in subjects with extreme hyperalphalipoproteinemia

INTRODUCTION AND OBJECTIVES

The association between HDL cholesterol (HDL-C) levels and death from cardiovascular disease follows a U-shaped pattern, increasing at the extremes. The objective of the study was to characterize a sample of subjects with extreme hyperalphalipoproteinemia (HAE).

MATERIAL AND METHODS

53 cases with HAE were recruited, 24 women (HDL-C>135mg/ dL) and 29 men (HDL-C>116mg/ dL). A detailed medical history was taken and questionnaires on adherence to the Mediterranean diet and physical activity were collected. Carotid ultrasounds were performed to detect the presence of suclinical atherosclerosis.

RESULTS

The most prevalent cardiovascular risk factor (CVRF) was dyslipidemia (64%) with no significant differences between men and women, unlike hypertension (21% in women, versus 55% in men, p=0.01) and others CVRF, for example, diabetes. 7% of the series had previous cardiovascular disease, women had higher LDL cholesterol (p=0.002) and HDL-C than men (without significant differences). Plaque was detected in 53% of cases, being more prevalent in men. Patients with plaque were older, drank more alcohol and smoked more (p<0.05).

CONCLUSIONS

Men had a higher prevalence of CVRF than women, except for dyslipidemia. Subclinical atherosclerosis occurred in more than half of the series. Age, alcohol consumption and smoking were independently associated with the presence of plaque, however, our data do not show a significant influence of HDL-C levels.

HDL-cholesterol concentration and its association with coronary artery calcification: a systematic review and meta-analysis

BACKGROUND

Coronary artery calcification (CAC) is a potential risk marker of coronary atherosclerosis that has high specificity and sensitivity. However, the association between high-density lipoprotein cholesterol (HDL-C) concentration and CAC incidence and progression is controversial.

METHODS

PubMed, Embase, Web of Science, and Scopus were systematically searched to identify relevant observational studies up to March 2023 and assessed the methodological quality using Newcastle-Ottawa Scale (NOS) scale. Random-effects meta-analysis was used to estimate pooled odds ratios (OR) and 95% confidence interval considering heterogeneity across studies.

RESULTS

Of the 2,411 records, 25 cross-sectional (n = 71,190) and 13 cohort (n = 25,442) studies were included in the systematic review. Ten cross-sectional and eight cohort studies were not eligible and were omitted from the meta-analysis. A total of 15 eligible cross-sectional studies (n = 33,913) were included in the meta-analysis and pooled results revealed no significant association between HDL-C and CAC > 0, CAC > 10, or CAC > 100 [pooled OR: 0.99 (0.97, 1.01)]. Meta-analysis of the 5 eligible prospective cohort studies (n = 10,721) revealed no significant protective effect of high HDL-C against CAC > 0 [pooled OR: 1.02 (0.93, 1.13)].

CONCLUSIONS

According to this analysis of observational studies, high HDL-C levels were not found to predict protection against CAC. These results suggest HDL quality rather than HDL quantity is important for certain aspects of atherogenesis and CAC.

REGISTRATION NUMBER

CRD42021292077.

Early Midlife Cardiovascular Health Influences Future HDL Metrics in Women: The SWAN HDL Study

Background Utility of high-density lipoprotein cholesterol (HDL-C) in assessing the antiatherogenic properties of HDL may be limited in midlife women. Novel metrics of HDL function, lipid contents, and subclasses may better reflect the atheroprotective capacities of HDL, supporting the need to evaluate how cardiovascular health affects these metrics in women. We assessed the relationship of early midlife Life's Simple 7 (LS7) score and its health behavior components with future HDL function (HDL-cholesterol efflux capacity), HDL-phospholipid, HDL-triglyceride, HDL particles (HDL-P) and size, and the relationship between LS7 score and changes in HDL metrics over time. Methods and Results We analyzed 529 women (baseline age: 46.4 [2.6] years, 57% White) from the SWAN HDL (Study of Women's Health Across the Nation HDL) study who had baseline LS7 followed by future repeated HDL metrics. Multivariable linear mixed models were used. Higher LS7 score was associated with favorable future HDL profile (higher HDL-phospholipid, total HDL-P and large HDL-P, lower HDL-triglyceride, and larger overall HDL size). Ideal body mass index was associated with higher HDL-cholesterol efflux capacity, HDL-phospholipid, and large HDL-P, lower HDL-triglyceride and small HDL-P, and larger overall HDL size. Ideal physical activity was associated with higher HDL-phospholipid, and total, large, and medium HDL-P. Ideal smoking was associated with less HDL-triglycerides. Diet was not related to HDL metrics. Higher LS7 score and ideal body mass index were associated with slower progression of HDL size over time. Conclusions Novel HDL metrics may better reflect the clinical utility of HDL. Improving lifestyle at midlife, particularly maintaining ideal body mass index, is associated with better future HDL phenotype.

The Influence of Menopause and Cardiorespiratory Fitness on Lipoprotein Particles in Midlife Women

Lipoprotein particles may provide better information about cardiovascular risk than standard cholesterol measures for women. Whether lipoprotein subclasses change with menopausal stage is unclear. Given the high prevalence of low cardiorespiratory fitness in midlife women and benefit to cardiovascular risk, it is also important to understand the effect of fitness on lipoprotein profiles.

PURPOSE

To evaluate the influence of menopausal status and fitness on lipoprotein particles in healthy midlife women.

METHODS

Lipoprotein particles were measured in high-(HIGH,n=25) and low-fit(LOW,n=13) perimenopausal and late postmenopausal women, and in HIGH premenopausal(n=10), perimenopausal(n=12), and late postmenopausal women(n=13).

RESULTS

There were larger low-density lipoprotein particles(LDL-P, 21.7±0.06vs.21.3±0.1nm, p=0.002), more large LDL-P(623.1±32.8vs.500.2±52.6nmol/L, p=0.045), and fewer small LDL-P(145.5±31.4vs. 311.5±44.7nmol/L, p=0.001) in HIGH vs. LOW. High-density lipoprotein particles(HDL-P) were larger(10.1±0.1vs.9.7±0.1nm, p=0.002) in HIGH, with more large(14.8±0.7vs.11.0±0.9μmol/L, p=0.002), medium(12.9±0.8vs. 8.4±0.9μmol/L, p=0.002), and fewer small HDL-P(10.2±1.1vs.15.4±1.6μmol/L, p=0.009) compared to LOW. HIGH postmenopausal women had more large LDL-P(662.9±47.5nmol/L) compared to premenopausal women(479.1±52.6nmol/L, p=0.035), and more HDL-P(40.2±1.1μmol/L) compared to premenopausal(34.9±1.5μmol/L, p=0.023) and perimenopausal women(35.4±1.3μmol/L, p=0.033).

CONCLUSION

High fitness positively influences lipoprotein particles in healthy perimenopausal and late postmenopausal women. In healthy fit women, menopause may not have a large influence on lipoprotein particles. Novelty Bullets: • In highly-fit women, menopause may not have a negative influence on lipoprotein particle subclasses. • High fitness is associated with a less atherogenic lipoprotein profile in perimenopausal and late postmenopausal women.