The U Shaped Relationship Between High-Density Lipoprotein Cholesterol and All-Cause or Cause-Specific Mortality in Adult Population

Abstract

Yu-qing Huang,1 Xiao-cong Liu,1 Kenneth Lo,1,2 Lin Liu,1 Yu-ling Yu,1 Chao-lei Chen,1 Jia-yi Huang,1 Ying-qing Feng,1 Bin Zhang1 1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People’s Republic of China; 2Department of Epidemiology, Centre for Global Cardio-Metabolic Health, Brown University, Providence, RI, USACorrespondence: Ying-qing Feng; Bin ZhangDepartment of Cardiology, Guangdong Cardiovascular Institute, 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 [phone]Email [email protected]; [email protected]: The associations of high-density lipoprotein cholesterol (HDL-C) with mortality are still unclear. We explored the associations of HDL-C with all-cause and cause-specific mortality in an adult population.Methods: Deaths were classified into all-cause, cardiovascular, and cancer mortality. Survival curve, multivariate Cox regression, and subgroup analyses were conducted, and hazard ratio (HR) and 95% confidence interval (CI) were performed. We fitted Cox regression models for all-cause, cardiovascular, and cancer mortality to evaluate their associations with categories of HDL-C (≤ 30, 31– 40, 41– 50, 51– 60 [reference], 61– 70, > 70 mg/dL).Results: A total of 42,145 (20,415 (48.44%) males, mean age 47.12± 19.40 years) subjects were enrolled. At an average follow-up of 97.52± 54.03 months, all-cause, cardiovascular, and cancer mortality numbers were 5,061 (12.01), 1,081 (2.56%), and 1,061 (2.52%), respectively. When compared with the reference group (HDL-C: 51– 60 mg/dL), a U-shaped association was apparent for all-cause mortality, with elevated risk in participants with the lowest (≤ 30 mg/dL) (HR=1.33; 95% CI=1.14– 1.56) and highest (> 70 mg/dL) (HR=1.14; 95% CI=1.02– 1.27) HDL-C concentration. Associations for cardiovascular and cancer mortality were non-linear. An elevated risk for cancer mortality was observed in those with the highest HDL-C concentration (HR=1.06; 95% CI– 0.84– 1.34) compared with the reference group, although it was not statistically significant. The effect of HDL-C on mortality was adjusted by some traditional risk factors including age, gender, race, or comorbidities.Conclusion: A U-shaped association was observed between HDL-C and all-cause mortality among an adult population.Keywords: high-density lipoprotein cholesterol, mortality, all-cause mortality, cause-specific mortality

Keywords

• high density lipoprotein cholesterol
• mortality
• all-cause mortality
• cause-specific mortality