Risk Management and Healthcare Policy (Oct 2020)
U-Shaped Association of High-Density Lipoprotein Cholesterol with All-Cause and Cardiovascular Mortality in Hypertensive Population
Abstract
Chao-lei Chen,1 Xiao-cong Liu,1 Lin Liu,1 Kenneth Lo,2 Yu-ling Yu,1 Jia-yi Huang,1 Yu-qing Huang,1 Ji-yan Chen1 1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People’s Republic of China; 2Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, RI, USACorrespondence: Yu-qing Huang; Ji-yan ChenDepartment of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou 510080, People’s Republic of ChinaTel/Fax +86-20-83827812Email [email protected]; [email protected]: Whether the paradox of high-density lipoprotein cholesterol (HDL-C) and elevated mortality risk extends to hypertensive patients is unclear. We aimed to investigate the association between HDL-C and all-cause and cardiovascular disease mortality in adults with hypertension.Methods: In the National Health and Nutrition Examination Surveys, 11,497 hypertensive participants aged ≥ 18years old and examined at baseline between 1999 and 2014 were followed up until December 2015. We categorized the HDL-C concentration as ≤ 30, 31– 40, 41– 50, 51– 60 (reference), 61– 70, > 70 mg/dL and examined their associations with all-cause and cardiovascular mortality, respectively. Multivariate Cox regression was used to calculated hazard ratio (HR) and 95% confidence interval (CI) for mortality risk.Results: During follow-up (median: 9.2 ± 3.8 years), 3012 deaths and 713 cardiovascular deaths were observed. In the restrictive cubic curves, associations of HDL-C levels and all-cause and cardiovascular mortality were detected to be U-shaped. After multivariable adjustment, HRs for all-cause mortality were for the lowest HDL-C concentration (≤ 30 mg/dL) 1.29 (95% CI, 1.07– 1.56) and the highest (> 70 mg/dL) 1.20 (1.06– 1.37), comparing with the reference group. For cardiovascular mortality, HRs were 1.31 (0.83– 1.48) and 1.09 (0.83– 1.43), respectively. Similar results were obtained in subgroups stratified by age, gender, race, and taking lipid-lowering drugs. The lowest all-cause mortality risk was observed at HDL-C 66 mg/dL (concentration) and 51– 60 mg/dL (range).Conclusion: Both lower and higher HDL-C concentration appeared to be associated with higher mortality in hypertensive population. Further investigation is warranted to clarify the underlying mechanisms.Keywords: all-cause mortality, high-density lipoprotein cholesterol, cardiovascular mortality, hypertension
