Although serum cholesterol is an established risk factor of cardiovascular events, the chronic inflammatory disease model challenges more and more the analogy of the “clogging pipe”, suggesting vessel plaques may be more than only dietary fat. Using data obtained from the SPRINT trial, this ancillary study assesses the impact of serum cholesterol regarding cardiovascular events.

SPRINT trial assessed the effects of hypertension management on the incidence of cardiovascular events on hypertensive non-diabetic patients (including death from cardiovascular causes, strokes, acute coronary syndromes, myocardial infarction and acute heart failure). Serum LDL-, HDL-cholesterol (LDL-C, HDL-C) and statin medication use were collected at baseline. Survival Cox regression analysis were performed.

A total of 9341 patients were included. Median follow-up was 3.26years. Global incidence of primary outcome was 6.0%. There was a protective association between HDL-C and the incidence of cardiovascular events (adjusted hazard-ratio (per 1mg/dl): 0.99; 95CI: 0.984–0.997; P=0.003). Patients under statin medication at baseline had an increased risk of cardiovascular events (adjusted hazard-ratio: 1.39; 95CI=1.178–1.642; P<0.001). LDL-C was not associated with the incidence of cardiovascular events, regardless of statin treatment (Table 1, Figure 1).

In this large cohort of hypertensive, non-diabetic patients, elevated LDL-C was not a risk factor of cardiovascular events, whereas low HDL-C was. These findings comfort the contemporary idea that atherosclerosis can’t only be explained by “clogging” plaques and call for further research.