Prevalence of low HDL cholesterol, and relationship between serum HDL and cardiovascular disease in elderly Spanish population: the PREV-ICTUS study

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Abstract
Objective: To assess the prevalence of low serum high‐density lipoprotein cholesterol (HDL‐C) concentration and the relationship between HDL‐C and established cardiovascular disease (CVD) in an elderly Mediterranean population. Methods: Analysis of Prevención del Riesgo de Ictus, a population‐based study on Spanish subjects aged ≥ 60 years. Low HDL‐C was defined following the European guidelines for cardiovascular prevention [men: < 40 mg/dl (< 1.0 mmol/l); women: < 46 mg/dl (< 1.2 mmol/l)]. The relationship between low HDL‐C or HDL‐C concentration (in quintiles) and CVD was assessed through multivariate models that included cardiovascular risk factors, statins and subclinical organ damage. Results: On 6010 subjects (71.7 years, 53.5% women), low HDL‐C was present in 17.5% [95% confidence interval (CI): 16.5–18.5] and was more frequent in women [20.4% (19.0–21.8) vs. 14.1% (12.8–15.4) in men p < 0.001] and in patients with diabetes, CVD or statin therapy. Low HDL‐C was independently associated with CVD [adjusted odds ratio (OR): 1.46, 95% CI: 1.22–1.74, p < 0.001]. The prevalence of CVD was higher as HDL‐C concentration was lower (chi‐square trend < 0.001). Compared with the highest quintile [> 65 mg/dl (> 1.67 mmol/l)], adjusted OR for CVD were 1.39 (1.10–1.76), 1.41 (1.11–1.80), 1.49 (1.18–1.89) and 1.91 (1.52–2.39), respectively for those in the fourth [57–65 mg/dl (1.46–1.67 mmol/l)], third [51–56 mg/dl (1.31–1.45 mmol/l)], second [46–50 mg/dl (1.18–1.30 mmol/l)] and first [< 46 mg/dl (< 1.18 mmol/l)] quintiles of HDL‐C. This association was seen in males and females. Conclusions: A total of 17.5% of this Spanish population aged ≥ 60 years had low HDL‐C. We found a strong, independent and inverse association between HDL‐C concentrations and established CVD, even at ranges of HDL‐C considered as normal.

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