HDL-cholesterol concentration and its association with coronary artery calcification: a systematic review and meta-analysis

Search results

The flowchart of literature search and selection process is presented in Fig. 1. Using systematic database searching, 2,403 potentially relevant publications were identified in the first evaluation, as well as eight studies, through a manual search of the reference lists of these papers. Subsequently, 1,141 duplicates and 1,109 irrelevant articles after screening titles and abstracts. The full texts of 161 potentially relevant publications were evaluated to determine if they met the eligibility criteria. Of these, 123 publications were excluded for the reasons mentioned in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Finally, 38 articles met the eligibility criteria and were involved in the qualitative synthesis (systematic review) [9,10,11,12, 15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48] and 20 were included in the quantitative synthesis (meta-analysis) [9, 11, 12, 16, 20, 22,23,24, 26,27,28, 32, 34, 35, 39,40,41, 45, 47, 48].

Fig. 1figure 1

Flow chart for selection of studies

Association between HDL-C and CAC in cross-sectional studiesStudy characteristics

Twenty-five included cross-sectional studies [9, 11, 12, 15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35, 47] enrolled 71,190 participants and the sample size ranged from 104 to 16,493 participants. Populations varied in sex distribution and age, and also had mean or median HDL-C levels. Nineteen studies included both genders [9, 11, 12, 15,16,17,18,19,20,21,22, 25, 26, 28,29,30,31,32, 47], four included only men [23, 24, 27, 33], and two included only women [34, 35]. The average age of study participants varied (22–94 years). Of the 25 included cross-sectional studies, 14 were conducted in America [9, 11, 15,16,17,18, 21, 22, 25, 29,30,31, 34, 35], one in Europe [19], and ten in Asia [12, 20, 23, 24, 26,27,28,

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