{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:22:49Z","timestamp":1793164969304,"version":"4.5.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,4,9]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A low level of high\u2010density lipoprotein\u2010cholesterol (\n              <jats:styled-content style=\"fixed-case\">HDL<\/jats:styled-content>\n              \u2010C) is a well\u2010known risk factor for cardiovascular events. Recent studies have also suggested that\n              <jats:styled-content style=\"fixed-case\">HDL<\/jats:styled-content>\n              \u2010C variability has a predictive role in patients with coronary artery disease. We investigated the combined effect of the mean and variability of\n              <jats:styled-content style=\"fixed-case\">HDL<\/jats:styled-content>\n              \u2010C on the risk of myocardial infarction (\n              <jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content>\n              ), stroke, and mortality in the general population.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We selected 5\u00a0433\u00a0098 subjects in the Korean National Health Insurance System cohort who had no history of\n              <jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content>\n              or stroke and who underwent \u22653 health examinations between 2009 and 2013. Visit\u2010to\u2010visit\n              <jats:styled-content style=\"fixed-case\">HDL<\/jats:styled-content>\n              \u2010C variability was calculated using the coefficient of variation, variability independent of the mean and average real variability. The low\u2010mean and high\u2010variability groups were defined as the lowest and highest quartiles of\n              <jats:styled-content style=\"fixed-case\">HDL<\/jats:styled-content>\n              \u2010C mean and variability, respectively. There were 27\u00a0605 cases of\n              <jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content>\n              , 31\u00a0162 cases of stroke, and 50\u00a0959 deaths during the median follow\u2010up of 5.1\u00b10.6\u00a0years. A lower mean or higher variability (coefficient of variation) of\n              <jats:styled-content style=\"fixed-case\">HDL<\/jats:styled-content>\n              \u2010C was associated with a higher risk of adverse outcomes, and the 2 measures had an additive effect. In the multivariable\u2010adjusted model, the hazard ratios (95% CIs) of the low\u2010mean\/high\u2010variability group compared with the high\u2010mean\/low\u2010variability group were 1.47 (1.41\u20131.54) for\n              <jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content>\n              , 1.23 (1.18\u20131.28) for stroke, and 1.41 (1.36\u20131.45) for all\u2010cause mortality. Results were consistent when variability was modeled using variability independent of the mean or average real variability, and in various sensitivity and subgroup analyses.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Low mean and high variability of\n              <jats:styled-content style=\"fixed-case\">HDL<\/jats:styled-content>\n              \u2010C is associated with an increased risk of\n              <jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content>\n              , stroke, and mortality.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.015493","type":"journal-article","created":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T09:00:20Z","timestamp":1586163620000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Impact of Mean and Variability of High\u2010Density Lipoprotein\u2010Cholesterol on the Risk of Myocardial Infarction, Stroke, and Mortality in the General Population"],"prefix":"10.1161","volume":"9","author":[{"given":"Byung\u2010Hun","family":"Han","sequence":"first","affiliation":[{"name":"College of Medicine The Catholic University of Korea Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyungdo","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics College of Medicine The Catholic University of Korea Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun\u2010Ho","family":"Yoon","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism Department of Internal Medicine Seoul St. Mary's Hospital College of Medicine The Catholic University of Korea Seoul Korea"},{"name":"Department of Medical Informatics College of Medicine The Catholic University of Korea Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mee Kyoung","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism Department of Internal Medicine Yeouido St. Mary's Hospital College of Medicine The Catholic University of Korea Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3964-3877","authenticated-orcid":false,"given":"Seung\u2010Hwan","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism Department of Internal Medicine Seoul St. Mary's Hospital College of Medicine The Catholic University of Korea Seoul Korea"},{"name":"Department of Medical Informatics College of Medicine The Catholic University of Korea Seoul 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