Levels of high-density lipoprotein cholesterol (HDL-C) were found to have an inverse relationship with baseline coronary plaque, total plaque (TP), and total non-calcified plaque (TNCP) volumes in patients with dyslipidemia with elevated triglycerides (TG), according to a study published in Atherosclerosis.

In this cross-sectional analysis, 80 patients were prospectively enrolled from the Effect of Vascepa on Improving Coronary Atherosclerosis in people with High Triglycerides Taking Statin Therapy trial, which was an ongoing multi-center, randomized, double‐blind, placebo‐controlled trial evaluating icosapentethyl on coronary plaque progression. Participants (ages, 30-85 years; mean age, 57.1±8.6; 57% women) had atherosclerosis (ie, ≥20% narrowing in a coronary artery confirmed by angiography or coronary computed tomography angiography [CCTA]), elevated fasting TG (200-499 mg/dL), elevated low-density lipoprotein levels (LDL‐C; levels ≥40 and ≤115 mg/dL), were on statin therapy, and had a stable diet and exercise routine for at least 4 weeks.

In this cohort, median log-TNCP volume was 113.1±210.3 mm3 for men and 70.0±225.6 mm3 for women (P =.13), median log-TP volume was 226.8±284.1 mm3 for women and 101.6±284.9 mm3 for men (P =.22).

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Baseline log-TNCP and log-TP were found to be associated with HDL-C levels (β, -0.05±0.02; P =.011 and β, -0.05±0.02; P =.015, respectively) in a univariate analysis. After correcting for age, sex, body mass index, baseline TG levels, diabetes, hypertension, and smoking, HDL-C remained independently associated with lower log-TNCP and log-TP volumes on CCTA in a multivariate analysis (β, -0.043±0.021; P =.042 and β, -0.046±0.022; P =0.035, respectively).

When participants were stratified by sex, the inverse associations between HDL-C levels and log-TNCP volumes (women: β, -0.066±0.026; P =.018; men: β, -0.038±0.034; P =.282) and between HDL-C levels and log-TN volumes (women: β, -0.077±0.025; P =.004; men: β, -0.033±0.036; P =.364) were only observed for women.

A major limitation of this study was that these results could not be correlated with beginning statin therapy or statin therapy duration, as the participants had to be on stable therapy for a minimum of 4 weeks. In addition, no information regarding the duration of statin therapy was available to the investigators.

“Our findings provide more detailed mechanistic evidence regarding the protective role of HDL-C in coronary atherosclerosis in a high-risk cohort,” noted the study authors.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Lakshmanan S, Shekar C, Kinninger A, et al. Association of high-density lipoprotein levels with baseline coronary plaque volumes by coronary CTA in the evaporate trial. Atherosclerosis. 2020;305:34-41. doi:10.1016/j.atherosclerosis.2020.05.014