Ann Lab Med 2020; 40(4): 297-305
HDL Subclass Analysis in Predicting Metabolic Syndrome in Koreans With High HDL Cholesterol Levels
Hyun Suk Yang, M.D., Ph.D.1, Mina Hur, M.D., Ph.D.2, Hanah Kim, M.D., Ph.D.2, Sun Jong Kim, M.D., Ph.D.3, Sojung Shin, M.S.4, and Salvatore Di Somma, M.D.5; on behalf of the GREAT Network
Departments of 1Cardiovascular Medicine, 2Laboratory Medicine, and 3Respiratory Medicine, Konkuk University School of Medicine, Seoul, Korea; 4Research Coordinating Center, Konkuk University Medical Center, Seoul, Korea; 5Department of Medical-Surgery Sciences and Translational Medicine, University La Sapienza Rome, Sant’Andrea Hospital, Rome, Italy
Corresponding author: Mina Hur, M.D., Ph.D.
Department of Laboratory Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea
Tel: +82-2-2030-5581 Fax: +82-2-2636-6764 E-mail:
Received: August 15, 2019; Revised: November 26, 2019; Accepted: January 22, 2020; Published online: July 1, 2020.
© Korean Society for Laboratory Medicine. All rights reserved.

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Background: High-density lipoprotein cholesterol (HDL-C) is a complex mixture of subclasses with heterogeneous atheroprotective activities. We analyzed HDL-C subclass in relation to cardiovascular risk and metabolic syndrome (MetS) in a population with high HDL-C levels.
Methods: A total of 300 Korean individuals with high HDL-C levels (≥2.331 mmol/L) were enrolled following a comprehensive general medical examination including body composition analysis. HDL3-C levels were measured using the HDL3-EX SEIKEN kit (Randox Ltd., Crumlin, UK) and non-HDL3-C levels were calculated by subtracting HDL3-C levels from total HDL-C levels.
Results: HDL3-C levels and HDL3-C proportion had a weak positive correlation with low-density lipoprotein cholesterol (LDL-C) and triglycerides (r=0.21, r=0.25; r=0.26, r=0.34, respectively, all P<0.001); in contrast, non-HDL3-C levels had a weak negative correlation with these parameters (r=-0.17 and r=-0.25, respectively, both P<0.005). HDL3-C levels and HDL3-C proportion were significantly higher in the MetS group (N=8) than in the non-MetS group (0.71 vs 0.63 mmol/L, P=0.001; 29.7 vs 25.8%, P=0.001, respectively); these were the only predictors of MetS among the lipid variables (areas under the curves [AUC]=0.84 and 0.83, respectively, both P=0.001).
Conclusions: In populations with high HDL-C levels, HDL-C subclass may provide a greater amount of information on cardiovascular risk and MetS than HDL-C levels alone.
Keywords: High-density lipoprotein cholesterol, Subclass, HDL3 cholesterol, Cardiovascular risk, Metabolic syndrome

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