Ethnic differences in HDL quantity, quality, and potential associations with coronary heart disease risk (original) (raw)

Scilletta, Sabrina, Welsh, Paul ORCID: https://orcid.org/0000-0002-7970-3643, Beazer, Jack David ORCID: https://orcid.org/0000-0001-6978-3072, Di Pino, Antonino and Sattar, Naveed ORCID: https://orcid.org/0000-0002-1604-2593(2025) Ethnic differences in HDL quantity, quality, and potential associations with coronary heart disease risk.Atherosclerosis, 411, 120565. (doi: 10.1016/j.atherosclerosis.2025.120565) (PMID:41202738)

Abstract

Background and aims: Ethnic differences in HDL cholesterol (HDL-c) may contribute to 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 nine 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.

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