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The study included 37,059 subjects (mean age 57.7±11.9 years;47% men) who were recruited from the Health Survey for England and Scottish Health Survey. Individual subject data were linked with the British National Health Service Central Registry to record mortality.
Over 326,016 person-years of follow-up, there were 2250 deaths, 649 due to cardiovascular disease. When compared with the reference group (1.5–1.99 mmol/L), individuals with the lowest (<1.0 mmol/L) or highest (?2.5 mmol/L) HDL-C levels had the highest cardiovascular risk; Hazard ratios (95% confidence interval) for all-cause death were 1.23 (1.06-1.44) and 1.25 (0.97 - 1.62), respectively. However, for cardiovascular death, subjects with the lowest HDL-C levels had the highest risk (hazard ratio 1.49 (1.15 - 1.94). These findings suggest a disconnect between concentration and function in individuals with high HDL-C levels, although further study is merited.