Atherosclerosis · 2025
Ethnic differences in HDL quantity, quality, and potential associations with coronary heart disease risk.
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Scilletta Sabrina, Welsh Paul, Beazer Jack David, Di Pino Antonino, Sattar Naveed
Аннотация
BACKGROUND AND AIMS: Ethnic differences in HDL cholesterol (HDL-c) may help explain disparities in coronary heart disease (CHD) risk, but the clinical interpretation of HDL-c and its metabolomic subfractions across populations remains unclear.
METHODS: We examined HDL quantity and quality in relation to ethnicity and CHD risk in UK Biobank. HDL-c and ten metabolomic HDL measures (reflecting particle size and lipid composition) were analyzed in relation to CHD using Cox models stratified by ethnicity. Linear regression assessed differences in HDL-c by ethnicity. Models were sequentially adjusted for sociodemographic, clinical, adiposity, and physical activity variables.
RESULTS: After adjustment, HDL-c concentrations were modestly lower in South Asian (-0.091 mmol/L) and Black (-0.025 mmol/L) participants compared to White participants. These differences were substantially attenuated after further adjustment for adiposity and physical activity. HDL-c was inversely associated with CHD across all ethnic groups, with the strongest association in South Asian (HR per SD: 0.40 [0.29-0.54]) compared with White participants (HR: 0.64 [0.61-0.67]). Several HDL subfractions (particularly large HDL particles and average HDL diameter) showed stronger inverse associations with CHD in South Asian participants compared to other ethnic groups.
CONCLUSIONS: Lower HDL-c concentrations in South Asian and Black vs White participants appear largely driven by differential physical activity and/or adiposity measures. In South Asian individuals, HDL quantity and quality measures may be more strongly predictive of risk, warranting further investigation into their clinical and biological utility in diverse populations.
METHODS: We examined HDL quantity and quality in relation to ethnicity and CHD risk in UK Biobank. HDL-c and ten metabolomic HDL measures (reflecting particle size and lipid composition) were analyzed in relation to CHD using Cox models stratified by ethnicity. Linear regression assessed differences in HDL-c by ethnicity. Models were sequentially adjusted for sociodemographic, clinical, adiposity, and physical activity variables.
RESULTS: After adjustment, HDL-c concentrations were modestly lower in South Asian (-0.091 mmol/L) and Black (-0.025 mmol/L) participants compared to White participants. These differences were substantially attenuated after further adjustment for adiposity and physical activity. HDL-c was inversely associated with CHD across all ethnic groups, with the strongest association in South Asian (HR per SD: 0.40 [0.29-0.54]) compared with White participants (HR: 0.64 [0.61-0.67]). Several HDL subfractions (particularly large HDL particles and average HDL diameter) showed stronger inverse associations with CHD in South Asian participants compared to other ethnic groups.
CONCLUSIONS: Lower HDL-c concentrations in South Asian and Black vs White participants appear largely driven by differential physical activity and/or adiposity measures. In South Asian individuals, HDL quantity and quality measures may be more strongly predictive of risk, warranting further investigation into their clinical and biological utility in diverse populations.