Coronary heart disease risks associated with high levels of HDL cholesterol.

The association between high-density lipoprotein cholesterol (hdl-c) and coronary heart disease (chd) events is not well described in individuals with very high levels of hdl-c (>80 mg/dl). using pooled data from 6 community-based cohorts we examined chd and total mortality risks across a broad range of hdl-c,including values in excess of 80 mg/dl. we used cox proportional hazards models with penalized splines to assess multivariable,adjusted,sex-stratified associations of hdl-c with the hazard for chd events and total mortality,using hdl-c 45 mg/dl and 55 mg/dl as the referent in men and women,respectively. analyses included 11 515 men and 12 925 women yielding 307 245 person-years of follow-up. in men,the association between hdl-c and chd events was inverse and linear across most hdl-c values; however at hdl-c values >90 mg/dl there was a plateau effect in the pattern of association. in women,the association between hdl-c and chd events was inverse and linear across lower values of hdl-c,however at hdl-c values >75 mg/dl there were no further reductions in the hazard ratio point estimates for chd. in unadjusted models there were increased total mortality risks in men with very high hdl-c,however mortality risks observed in participants with very high hdl-c were attenuated after adjustment for traditional risk factors. we did not observe further reductions in chd risk with hdl-c values higher than 90 mg/dl in men and 75 mg/dl in women.