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

• Published in: Clinical interventions in aging 2020-01, Vol.15, p.1883-1896
• Main Authors: Huang, Yu-Qing, Liu, Xiao-Cong, Lo, Kenneth, Liu, Lin, Yu, Yu-Ling, Chen, Chao-Lei, Huang, Jia-Yi, Feng, Ying-Qing, Zhang, Bin
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Aging; all-cause mortality; Antihypertensives; Blood pressure; Body mass index; Cancer; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - mortality; Cause of Death; cause-specific mortality; China - epidemiology; Cholesterol; Cholesterol, HDL - metabolism; Diabetes; Disease control; Disease prevention; Drugs; Education; Female; Gender; HDL cholesterol; Health aspects; high density lipoprotein cholesterol; Humans; Hypertension; Laboratories; Lipids; Lipoproteins; Male; Measurement; Medical prognosis; Middle Aged; Mortality; Neoplasms - mortality; Older people; Original Research; Patient outcomes; Prognosis; Proportional Hazards Models; Regression analysis; Risk Factors; Survival analysis; United States
• ISSN: 1178-1998; 1176-9092; 1178-1998
• DOI: 10.2147/CIA.S271528

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. 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). 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. A U-shaped association was observed between HDL-C and all-cause mortality among an adult population.