Diabetes, Metabolic Syndrome and Obesity (Jun 2021)
A Non-Linear Association of High-Density Lipoprotein Cholesterol with All-Cause and Cause-Specific Mortality in Diabetic Patients
Abstract
Yu-qin Yan,1,* Jun Chen,1,* Yu-qing Huang2 1Department of Cardiology, People’s Hospital of Shenzhen Baoan District, Shenzhen, 518100, People’s Republic of China; 2Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yu-qing HuangDepartment of Cardiology, 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]: The association between high-density lipoprotein cholesterol (HDL-C) and the risk of death among people with diabetes remains to be verified.Methods: This was a nationwide, population-based cohort study in United States. A total of 6549 diabetes patients were included from the National Health and Nutrition Examination Surveys (NHANES). HDL-C concentration was divided into quintiles, and the lowest risk group (Q4: 1.32 to 1.53 mmol/L) was used as reference. Multivariate Cox proportional hazards models and restrictive cubic curves were performed to estimate hazard ratios (HRs) with 95% confidence interval (CI) for all-cause and cause-specific mortality.Results: During a median follow-up of 82.36 ± 50.11 months, 1546 (23.61%) cases of all-cause, 389 (5.94%) cardiovascular and 262 (4.00%) cancer mortality have occurred, respectively. After adjusting for potential covariates, a U-shaped association was found between HDL-C and all-cause mortality (minimum mortality risk at 1.37 mmol/L); the risk for all-cause mortality was significantly higher in the groups with HDL-C concentration < 0.96 mmol/L (HR: 1.30; 95% CI: 1.09, 1.56; P=0.0046) and with HDL-C concentration ≥ 1.55 mmol/L (HR: 1.20; 95% CI: 1.00, 1.44; P=0.0481) than participants with HDL-C concentrations ranging from 1.32 to 1.53mmol/L. Nonlinear associations of HDL-C levels with both cardiovascular and cancer mortality were also observed.Conclusion: A non-linear association was observed association of HDL-C with all-cause, cardiovascular and cancer mortality among diabetic patients.Keywords: high-density lipoprotein cholesterol, diabetes, mortality, all-cause mortality, cause-specific mortality, dose-dependent
