A prospective, population-based study found a person’s high-density lipoprotein (HDL) cholesterol function had a statistically significant association with incident coronary heart disease events.

People with the highest measures of HDL cholesterol function at the beginning of the study had fewer heart attacks and other cardiovascular events later in life, according to lead researcher Danish Saleheen, PhD, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

Saleheen and his colleagues published their findings online in The Lancet Diabetes & Endocrinology on May 26.

They examined data from the EPIC-Norfolk study, which included 25,693 men and women between the ages of 40 and 79 who lived in the United Kingdom, and conducted a baseline survey between 1993 and 1997. They then identified 1,745 people who developed fatal or nonfatal coronary heart disease as of March 2009.

The researchers found that the people who developed coronary heart disease had significantly lower mean cholesterol efflux capacity compared with the control group. They defined cholesterol efflux capacity as a measure of the ability of HDL to promote cholesterol removal from lipid-laden macrophages.

In addition, people who developed incident coronary heart disease were older and more heavy and were more likely to have a history of diabetes, hypertension and smoking. They also had higher triglyceride and low-density lipoprotein cholesterol and lower HDL cholesterol.

“Although we have shown an inverse relationship between cholesterol efflux capacity and risk of incident coronary heart disease, the causal nature of this relationship is uncertain,” the researchers wrote. “Further studies with information about genotypes and other traits are needed to exclude residual confounding and assess the cause of this association through a mendelian randomization study.”