Abstract 11599: High-Density Lipoprotein Cholesterol and Statin Use for Primary Prevention Among US Adults With Intermediate 10-year Predicted ASCVD Risk

Introduction: Although there is no strong evidence of a causal relationship between high-density lipoprotein cholesterol (HDL-C) with atherosclerotic cardiovascular disease (ASCVD), HDL-C is considered “good cholesterol” by many which may impact decision making around statin use. We determined if statin use for primary prevention differed by HDL-C levels among adults without ASCVD, diabetes mellitus (DM), or low-density lipoprotein cholesterol (LDL-C) >190 mg/dL but an intermediate 10-year predicted ASCVD risk.

Methods: National Health and Nutrition Examination Surveys (NHANES) participants who were non-pregnant, 40-75 years with a 10-year ASCVD risk 7.5-<20% and fasting lipids, and without ASCVD, DM, LDL-C

190 mg/dL, or triglycerides ≥500 mg/dL from 2013-2020 were included. Multivariable Poisson regression with robust error variance estimated adjusted prevalence and prevalence ratios (PRs) and 95% confidence intervals (CIs) for statin use associated with HDL-C levels (low [<40 mg/dL], normal [40-60 mg/dL], high [ 60 mg/dL]). Models were adjusted for age, race, ethnicity, sex, education, healthcare access within 12 months, routine location for health care, health insurance, LDL-C, and body mass index.

Results: Among 999 included US adults (representing 23.7 million adults) with a 10-year predicted ASCVD risk 7.5-<20%, the multivariable adjusted prevalence of statin use was 32.5%, 28.6%, and 24.4% among adults with low HDL-C, normal HDL-C, and high HDL-C, respectively. After adjustment, the PR for statin use among adults with low HDL-C was 1.14 (95% CI 1.01,1.18) and high HDL-C was 0.85 (95% 0.83,0.88) vs. adults with normal HDL-C (Figure 1).

Discussion In the current analysis, adults with high HDL-C were less likely to be taking a statin, while adults with low HDL-C were more likely. HDL-C may influence the decision to use statin medication among adults with intermediate 10-year ASCVD risk despite evidence that HDL-C level is not causally related to ASCVD.