Clinical Investigation
Association between high-density lipoprotein cholesterol level and cardiovascular disease and all-cause mortality in the elderly population
Yu Jiaxin, Wu Shouling, Chen Shuohua, Liu Yan, Feng Mingkun, Yang Yang, Li Shaojun, Liu Xiaokun, Yang Ning, Li Yuming
Published 2022-08-24
Cite as Chin J Cardiol, 2022, 50(8): 791-798. DOI: 10.3760/cma.j.cn112148-20220307-00160
Abstract
ObjectiveTo investigate the relationship between high density lipoprotein cholesterol (HDL-C) and cardiovascular disease (CVD) and all-cause mortality in the elderly population.
MethodsA total of 14 355 elderly persons aged ≥65 years, who participated in the annual physical examination in Kailuan Group in 2006 were included in this prospective cohort study. According to HDL-C level, the participants were divided into 4 groups: low-level group (HDL-C<1.30 mmol/L), intermediate-level group (1.30 mmol/L ≤HDL-C≤1.54 mmol/L), medium-high-level group (1.55 mmol/L ≤HDL-C≤1.80 mmol/L), high-level group (HDL-C≥1.81 mmol/L). Baseline data such as age, sex and blood lipid levels were collected and compared. Inpatient medical records and death information were obtained through the social security system, and CVD and all-cause mortality were analyzed. After adjusting for confounding factors, the medium-high-level group was used as the reference group. Cox proportional risk regression model was used to evaluate the impact of HDL-C on CVD and all-cause mortality events. The linear or nonlinear relationship between HDL-C level and CVD and all-cause mortality events was evaluated by restricted cubic spline regression model. Death competitive risk analysis was conducted, and sensitivity analysis was performed after excluding subjects with CVD or all-cause mortality within 1 year of follow-up and female participants.
ResultsThe average age of this cohort was (71.5±5.5) years and follow-up time was (10.9±3.3) years. Compared with medium-high-level group, Cox proportional risk regression analysis showed that the HR (95%CI) of CVD and all-cause mortality in low-level group were 1.21 (1.06-1.38) (P<0.05) and 1.02 (0.95-1.11) (P>0.05), respectively; the HR (95%CI) of CVD events in high-level group was 1.17 (1.03-1.33) (P<0.05), and there was a marginal significant association with all-cause mortality, the HR (95%CI) was 1.07 (1.00-1.16) (0.05<P<0.1). The restricted cubic spline regression analysis showed that HDL-C was nonlinearly correlated with CVD (nonlinear correlation P<0.1), and presented a U-shaped curve trend, while HDL-C was linearly correlated with all-cause mortality (nonlinear correlation P>0.1).
ConclusionsIn the elderly population, the risk of CVD is lowest when the HDL-C level is 1.55-1.80 mmol/L, either high or low HDL-C is a risk factor for CVD. High HDL-C tends to be related to increased risk of all-cause mortality and low HDL-C is not related to increased risk of all-cause mortality.
Key words:
Aged; High density lipoprotein cholesterol; Cardiovascular disease; All-cause mortality
Contributor Information
Yu Jiaxin
Department of Cardiology, Tangshan Worker′s Hospital, Tangshan 063000, China
Wu Shouling
Department of Cardiology, Kailuan General Hospital, Tangshan 063000, China
Chen Shuohua
Department of Cardiology, Kailuan General Hospital, Tangshan 063000, China
Liu Yan
Department of Cardiology, Kailuan General Hospital, Tangshan 063000, China
Feng Mingkun
Department of Cardiology, Tangshan Worker′s Hospital, Tangshan 063000, China
Yang Yang
Department of Cardiology, Tangshan Worker′s Hospital, Tangshan 063000, China
Li Shaojun
Tangshan Hospital of Traditional Chinese Medicine, Clinical Laboratory, Tangshan 063000, China
Liu Xiaokun
Department of Cardiology, Tangshan Worker′s Hospital, Tangshan 063000, China
Yang Ning
Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin 300457, China
Li Yuming
Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin 300457, China
