| Title: | Association between high-density lipoprotein cholesterol and risk of abdominal aortic aneurysm among males and females aged 60 years and over |
| Journal: | Journal of Vascular Surgery |
| Published: | 16 Dec 2024 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/39694150/ |
| DOI: | https://doi.org/10.1016/j.jvs.2024.12.004 |
Publication 14735
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Abstract
OBJECTIVE: Whether high-density lipoprotein cholesterol (HDL-C) has a protective role against abdominal aortic aneurysm (AAA) development in both older males and females remains uncertain. This study aims to assess the sex-specific association between HDL-C and incident AAA in older adults from the UK Biobank.</p>
METHODS: This cohort study included 86,184 males and 95,682 females aged ≥60 years from the UK biobank. Baseline HDL-C was modelled either as a continuous or categorical variable. The primary outcome was incident AAA. Cox proportional hazard models were used for sex-stratified analysis, adjusting for baseline confounders. Restricted cubic splines were plotted to visualize any nonlinear relationship. Harrell's C-index was calculated to assess the added value of HDL-C to the discrimination of model including age and smoking.</p>
RESULTS: Over a mean follow-up of 14.4 years, 1549 and 328 incident AAA were observed in males and females, respectively. Adjusted hazard ratios for AAA with a 1-mmol/L HDL-C increase was 0.26 (95% confidence interval, 0.21- 0.32) and 0.31 (95% confidence interval, 0.21-0.46) in males and females, respectively (both P < .001). Consistent with the results from Cox model modelling HDL-C as a categorical variable showing an inverse and dose-dependent relationship between HDL-C and incident AAA in both sexes, restricted cubic splines confirmed the monotonic, inverse associations. Adding HDL-C to a model including age and smoking significantly improve the model discrimination for AAA in both sexes (C-index +2.1% in males and +1.5% in females; both P < .05).</p>
CONCLUSIONS: This study revealed a significant association between low HDL-C levels and a high risk of incident AAA in both older males and females, suggesting the potential clinical usefulness of HDL-C for AAA risk stratification. Our study was limited by its observational design and the presence of possible residual confounding. Studies using real-world data are warranted to evaluate the practical implications of incorporating HDL-C into AAA screening guidelines and its impact on patient outcomes.</p>
17 Keywords
- Age Factors
- Aged
- Aortic Aneurysm, Abdominal
- Biomarkers
- Cholesterol, HDL
- Dyslipidemias
- Female
- Humans
- Incidence
- Male
- Middle Aged
- Protective Factors
- Risk Assessment
- Risk Factors
- Sex Factors
- Time Factors
- United Kingdom
14 Authors
- Zhaoxi Peng
- Peng Qiu
- Hongbin Guo
- Chao Zhu
- Jiazhen Zheng
- Hongji Pu
- Yijun Liu
- Weiqing Wei
- ChenShu Li
- Xinrui Yang
- Kaichuang Ye
- Ruihua Wang
- Xinwu Lu
- Zhen Zhou
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