There are many risk factors that predict the coronary heart disease (CHD) status of a patient – including all the various lipid subfractions, lifestyle, genetic predisposition, etc. – but here the focus will be on the association between serum high-density lipoprotein (HDL) cholesterol and CHD. The Figure shows the strong inverse relationship between serum HDL cholesterol levels and the presence of CHD. There is absolutely no doubt that there is a robust inverse correlation between HDL cholesterol levels and CHD, or cardiovascular disease (CVD) in general.
The upper (orange) line in the Figure shows the values once they have been adjusted for age and gender, and the lower (blue) line shows the values adjusted for every other factor that could be measured, meaning adjustment for other lipid subfractions, blood pressure, diabetes, family history, age, gender, and smoking.
Moreover this analysis, performed by the Emerging Risk Factors Collaboration,[12] was based on individual patient data from >300,000 people, so the error margins are small and the data are extremely robust. Whether the data are adjusted only for age and gender, or are adjusted for many other factors, lower serum HDL cholesterol levels are highly and significantly predictive of an increase in CHD risk.
J Clin Lipidol. 2011; 5(6).[12]The Emerging Risk Factors Collaboration. Lipoprotein(a) Concentration and the Risk of Coronary Heart Disease, Stroke, and Nonvascular Mortality. JAMA. 2009;302(4):412- 423.
