Background: Increased high-density lipoprotein cholesterol (HDL-C) levels driven by alcohol consumption may not be cardioprotective and have been linked to higher mortality risk. We investigated the association between extremely high HDL-C levels and all-cause mortality across alcohol drinking status among hypertensive adults. Methods: We analyzed 20,381 hypertensive participants from the China Stroke Primary Prevention Trial (CSPPT) Study. Extremely high HDL-C levels were defined as a serum HDL-C levels ≧ 90 mg/dL. Alcohol drinking status was assessed using a supervised questionnaire. The primary outcome is all-cause mortality. Results: At baseline, the mean age was 60.00±7.53 years, 59.00% were female, and 1.44% were identified as having extremely high HDL-C levels. During a median follow-up of 4.48 (4.01, 4.71) years, 615 patients died. We found a J-shape association between HDL-C levels and all-cause mortality, with the risk significantly elevated among those with extremely high HDL-C levels. Compared to participants with a moderate HDL-C levels (men: 40-59 mg/dL; women: 50-59 mg/dL), those with extremely high HDL-C levels had 121% increased risk of all-cause mortality, with an adjusted hazard ratio (HR) of 2.21 (95% CI, 1.36-3.58; p =0.001). Notably, such an association was only significant among current drinkers and was null in never drinkers. Conclusions: Extremely high HDL-C levels were only associated with increased risk of all-cause mortality among hypertensive adults who are current drinkers, but not among never drinkers.
Hu et al. (2026) studied this question.