The following is a summary of “Race-Dependent Association of High-Density Lipoprotein Cholesterol Levels With Incident Coronary Artery Disease” published in the November 2022 issue of Cardiology by Zakai et al.

Due in part to racial differences in lipid connections with coronary heart disease (CHD), plasma lipids are risk factors for the condition. For a study, researchers sought to determine why Black individuals performed poorly in CHD risk calculations.

The REGARDS (REasons for Geographic and Racial Differences in Stroke) cohort enrolled 30,239 Black and White people ≥45 years from the contiguous United States between 2003 and 2007. To calculate the race-specific risk of plasma lipid levels with incident CHD, they utilized Cox regression models adjusted for clinical and behavioral risk variables (myocardial infarction or CHD death).

In 23,901 CHD-free subjects (57.8% White and 58.4% women, mean age 64±9 years), 664 and 951 CHD occurrences occurred in Black & White adults, respectively, following a median follow-up of 10 years. Triglycerides and low-density lipoprotein cholesterol were linked to a higher risk of CHD in both races (P interaction by race >0.10). Regarding sex-specific clinical HDL-C categories, low HDL-C was linked to an increased risk of CHD in White adults (HR: 1.22; 95% CI: 1.05-1.43) but not in Black adults (HR: 0.94; 95% CI: 0.78-1.14) (P interaction by race = 0.08); high HDL-C was not linked to a reduction in CHD events in either race (HR: 0.96; 95% CI: 0.79-1.16 for White participants and HR: 0.91; 95% CI: 0.74-1.12 for Black adults).

Triglycerides and low-density lipoprotein cholesterol only slightly influenced the risk of CHD in individuals of both races. In White adults, but not Black people, low HDL-C was linked to an increased risk of CHD, whereas in high HDL-C was not protective in either group. Current risk calculations based on high-density lipoprotein cholesterol could result in erroneous risk assessment in Black adults.

Reference: jacc.org/doi/10.1016/j.jacc.2022.09.027