HDL Particles May More Accurately Predict MI, Stroke Risk

High-density lipoprotein particle concentration (HDL-P) appears to be a more reliable predictor of myocardial infarction (MI) and ischemic stroke risk than high-density lipoprotein cholesterol concentration (HDL-C) for many patient populations, according to a new analysis1 of 4 large population studies. 

However, a measurement to accurately predict MI among Black patients is still needed, as neither HDL measurement was significantly associated with MI among this patient population.

“Previous studies have looked at HDL levels in the population as a whole,” study coauthor Anand Rohatgi, MD, said in a press release.2 “But we know that sometimes biology differs by gender and race, so we thought it was important to separately tease apart what’s happening in those populations, as well as how HDL is associated with stroke, which has been understudied.”

To better understand the associations of HDL-C and HDL-P with ischemic stroke and MI among the understudied patient populations of women and Black adults, the researchers analyzed data on patients without baseline atherosclerotic cardiovascular disease (ASCVD) from the Dallas Heart Study (n=2535), the Atherosclerotic Risk in Communities Study (n=1595), the Multi Ethnic Study of Atherosclerosis (n=6632), and the Prevention of Renal and Vascular Endstage Disease (n=5022).

After adjusting for cardiometabolic risk factors, both HDL-P and HDL-C were inversely associated with the combined outcome of MI and ischemic stroke among the overall population (N=15,784).

Adjusting for HDL-C did not attenuate the inverse relationship between HDL-P and ASCVD. However, adjusting for HDL-P attenuated all associations between HDL-C and events.

Among the overall population—including among women—HDL-P was inversely associated with the individual endpoints of MI and ischemic stroke. 

However, HDL-P was inversely associated with MI only among white participants—not among Black participants. And while HDL-C was inversely associated with MI among white participants, the direct association between HDL-C and MI among Black participants was weak.

“If you’re white, low HDL cholesterol is still a powerful predictor of heart attack and stroke risk, and that has not changed,” Dr Rohatgi said in the press release.2 “But if you’re not white, it’s not that straightforward.”

Differential associations of both HDL-C and HDL-P for MI by Black ethnicity suggest that ASCVD risk may differ by vascular domain and ethnicity,” the researchers concluded.1 “Future studies should examine individual outcomes separately.”

—Colleen Murphy


  1. Singh K, Chandra A, Sperry T, et al. Associations between HDL particles and ischemic events by vascular domain, gender, and ethnicity: a pooled cohort analysis. Circulation. Published online June 18, 2020. doi:10.1161/CIRCULATIONAHA.120.045713
  2. Better measure of ‘good cholesterol’ can gauge heart attack and stroke risk in some populations. News release. UT Southwestern Medical Center; June 22, 2020. Accessed June 24, 2020.