# HDL Cholesterol Is Remarkably Cardioprotective Against Coronary Artery Disease in Native Hawaiians and Pacific Islanders

## TL;DR

HDL cholesterol is more protective against heart disease in Native Hawaiians and Pacific Islanders compared to the general population.

## Contribution

This study reveals a stronger cardioprotective effect of HDL-C in Native Hawaiians and Pacific Islanders using a large-scale health data analysis.

## Key findings

- HDL-C was more strongly associated with reduced CAD risk in NHPIs (HR: 0.32) compared to the general cohort (HR: 0.57).
- Low HDL-C increases risk for both CAD and T2D in NHPIs according to spline analysis.
- Tailored clinical assessments for NHPIs are suggested based on the pronounced protective role of HDL-C in this population.

## Abstract

High-density lipoprotein cholesterol (HDL-C) is inversely associated with cardiometabolic risk and exhibits nonlinear effects at extreme levels. Cardiometabolic diseases are a leading cause of death and are particularly prevalent among Native Hawaiian and Pacific Islanders (NHPIs).

This study characterizes HDL-C’s association with coronary artery disease (CAD), major adverse cardiovascular events (MACE), and type 2 diabetes (T2D) in NHPIs compared to the general population.

Using electronic health record data from the National Institutes of Health All of Us Research Program, we applied Cox proportional hazards models to compare HDL-C’s protective effects on CAD, MACE, and T2D between 261 NHPIs and the remaining cohort (n = 188,802). Models were adjusted for key confounders, and restricted cubic splines were used to assess nonlinear risk dynamics.

Tracking individuals across 10,534,661 person-years (mean age 55.7 ± 15.8 years, 38% male), HDL-C was more strongly associated with reduced CAD risk in NHPIs (HR: 0.32; 95% CI: 0.19-0.54) than in the general cohort (HR: 0.57; 95% CI: 0.56-0.58). A marginally stronger association was observed for MACE (NHPI HR: 0.40; 95% CI: 0.23-0.71 vs general HR: = 0.54; 95% CI: 0.53-0.56), while T2D associations were similar. Spline analysis indicated that low HDL-C increases risk for both CAD and T2D in NHPIs.

HDL-C’s protective role against cardiometabolic diseases is more pronounced in NHPIs, particularly for CAD. These findings support further investigation into tailored clinical assessments for this population.