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Association between low-density lipoprotein cholesterol and cardiovascular mortality in statin non-users: a prospective cohort study in 14.9 million Korean adults
Abstract Background Limited information is available on detailed sex/age-specific associations between low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease (CVD) mortality and ‘the optimal range’ associated with the lowest CVD mortality in the general population. Methods Korean adu...
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| Published in: | International journal of epidemiology 2022-08, Vol.51 (4), p.1178-1189 |
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| container_end_page | 1189 |
| container_issue | 4 |
| container_start_page | 1178 |
| container_title | International journal of epidemiology |
| container_volume | 51 |
| creator | Yi, Sang-Wook An, Sang Joon Park, Hyung Bok Yi, Jee-Jeon Ohrr, Heechoul |
| description | Abstract
Background
Limited information is available on detailed sex/age-specific associations between low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease (CVD) mortality and ‘the optimal range’ associated with the lowest CVD mortality in the general population.
Methods
Korean adults (N = 14 884 975) who received routine health screenings during 2009–2010 were followed until 2018 for CVD mortality.
Results
During 8.8 years (mean) of follow-up, 94 344 individuals died from CVD. LDL-C had U-curve associations with mortality from CVD and its subtypes, except haemorrhagic stroke. Optimal range was 90–149 mg/dL for CVD; 70–114 for ischaemic heart disease; 85–129 for ischaemic stroke; ≥85 for subarachnoid haemorrhage; ≥130 for intracerebral haemorrhage; 115–159 for hypertension and heart failure; and 100–144 for sudden cardiac death. Assuming linear associations between 100 and 300 mg/dL, LDL-C was positively associated with CVD mortality [hazard ratio (HR) per 39-mg/dL (1-mmol/L) higher LDL-C = 1.10], largely due to ischaemic heart disease (HR = 1.26), followed by sudden cardiac death (HR = 1.13), ischaemic stroke (HR = 1.11) and heart failure (HR = 1.05). Intracerebral haemorrhage (HR = 0.90), but not subarachnoid haemorrhage, had inverse associations. Women and older adults had weaker positive associations than men and younger adults (Pinteraction |
| doi_str_mv | 10.1093/ije/dyac029 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9798292</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ije/dyac029</oup_id><sourcerecordid>2633899343</sourcerecordid><originalsourceid>FETCH-LOGICAL-c412t-7a4550c458e1c8832954dbdc0a8679c74bf4036f2b2449aae153150d1f82b80f3</originalsourceid><addsrcrecordid>eNp9kUuLFDEURoMoTju6ci9ZiSA1k1c94kIYBl844EbXIZXcsjOkkjJJ9dB_x19q2m4H3bi6i5yce_k-hJ5TckGJ5JfuFi7tXhvC5AO0oaITDe-G9iHaEE5I0_Y9PUNPcr4lhAoh5GN0xltGBy7EBv28yjkap4uLAY9Q7gAC9vGusRCyK3vs3RKXFAu4gM02esgFUvRYB4uNTtbFnc5m9TrhOaai_eFTZXOpzoBDDM2aIeU3WOPqyQuY4naATdxWvGKr_c1TcSHx7Lw_HPI5JtABa7v6kp-iR5P2GZ6d5jn69v7d1-uPzc2XD5-ur24aIygrTa9F2xIj2gGoGQbOZCvsaA3RQ9dL04txEoR3ExtZDUFroC2nLbF0Gtg4kImfo7dH77KOM1gDoSTt1ZLcrNNeRe3Uvy_BbdX3uFOylwOTrApenQQp_lhrUGp22YD3OkBcs2Id54OUXPCKvj6ipkaSE0z3ayhRh1ZVbVWdWq30i78vu2f_1FiBl0cgrst_Tb8Afu2xCw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2633899343</pqid></control><display><type>article</type><title>Association between low-density lipoprotein cholesterol and cardiovascular mortality in statin non-users: a prospective cohort study in 14.9 million Korean adults</title><source>Oxford University Press:Jisc Collections:OUP Read and Publish 2024-2025 (2024 collection) (Reading list)</source><creator>Yi, Sang-Wook ; An, Sang Joon ; Park, Hyung Bok ; Yi, Jee-Jeon ; Ohrr, Heechoul</creator><creatorcontrib>Yi, Sang-Wook ; An, Sang Joon ; Park, Hyung Bok ; Yi, Jee-Jeon ; Ohrr, Heechoul</creatorcontrib><description>Abstract
Background
Limited information is available on detailed sex/age-specific associations between low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease (CVD) mortality and ‘the optimal range’ associated with the lowest CVD mortality in the general population.
Methods
Korean adults (N = 14 884 975) who received routine health screenings during 2009–2010 were followed until 2018 for CVD mortality.
Results
During 8.8 years (mean) of follow-up, 94 344 individuals died from CVD. LDL-C had U-curve associations with mortality from CVD and its subtypes, except haemorrhagic stroke. Optimal range was 90–149 mg/dL for CVD; 70–114 for ischaemic heart disease; 85–129 for ischaemic stroke; ≥85 for subarachnoid haemorrhage; ≥130 for intracerebral haemorrhage; 115–159 for hypertension and heart failure; and 100–144 for sudden cardiac death. Assuming linear associations between 100 and 300 mg/dL, LDL-C was positively associated with CVD mortality [hazard ratio (HR) per 39-mg/dL (1-mmol/L) higher LDL-C = 1.10], largely due to ischaemic heart disease (HR = 1.26), followed by sudden cardiac death (HR = 1.13), ischaemic stroke (HR = 1.11) and heart failure (HR = 1.05). Intracerebral haemorrhage (HR = 0.90), but not subarachnoid haemorrhage, had inverse associations. Women and older adults had weaker positive associations than men and younger adults (Pinteraction < 0.001 for both sex and age). Individuals aged 75–84 years had modest positive associations with CVD mortality, especially ischaemic heart disease and ischaemic stroke.
Conclusion
LDL-C had U-curve associations for CVD mortality. The associations and optimal ranges differed across CVD subtypes. Women and older adults had weaker positive associations than men and younger adults. Positive associations with ischaemic heart disease and ischaemic stroke were maintained in adults aged 75–84 years.</description><identifier>ISSN: 0300-5771</identifier><identifier>ISSN: 1464-3685</identifier><identifier>EISSN: 1464-3685</identifier><identifier>DOI: 10.1093/ije/dyac029</identifier><identifier>PMID: 35218344</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Aged, 80 and over ; Brain Ischemia ; Cardiovascular Disease ; Cardiovascular Diseases ; Cerebral Hemorrhage ; Cholesterol, LDL ; Death, Sudden, Cardiac ; Female ; Heart Failure ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Ischemic Stroke ; Male ; Myocardial Ischemia ; Prospective Studies ; Republic of Korea - epidemiology ; Risk Factors ; Stroke - epidemiology</subject><ispartof>International journal of epidemiology, 2022-08, Vol.51 (4), p.1178-1189</ispartof><rights>The Author(s) 2022; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association 2022</rights><rights>The Author(s) 2022; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c412t-7a4550c458e1c8832954dbdc0a8679c74bf4036f2b2449aae153150d1f82b80f3</citedby><cites>FETCH-LOGICAL-c412t-7a4550c458e1c8832954dbdc0a8679c74bf4036f2b2449aae153150d1f82b80f3</cites><orcidid>0000-0002-6656-6205</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35218344$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yi, Sang-Wook</creatorcontrib><creatorcontrib>An, Sang Joon</creatorcontrib><creatorcontrib>Park, Hyung Bok</creatorcontrib><creatorcontrib>Yi, Jee-Jeon</creatorcontrib><creatorcontrib>Ohrr, Heechoul</creatorcontrib><title>Association between low-density lipoprotein cholesterol and cardiovascular mortality in statin non-users: a prospective cohort study in 14.9 million Korean adults</title><title>International journal of epidemiology</title><addtitle>Int J Epidemiol</addtitle><description>Abstract
Background
Limited information is available on detailed sex/age-specific associations between low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease (CVD) mortality and ‘the optimal range’ associated with the lowest CVD mortality in the general population.
Methods
Korean adults (N = 14 884 975) who received routine health screenings during 2009–2010 were followed until 2018 for CVD mortality.
Results
During 8.8 years (mean) of follow-up, 94 344 individuals died from CVD. LDL-C had U-curve associations with mortality from CVD and its subtypes, except haemorrhagic stroke. Optimal range was 90–149 mg/dL for CVD; 70–114 for ischaemic heart disease; 85–129 for ischaemic stroke; ≥85 for subarachnoid haemorrhage; ≥130 for intracerebral haemorrhage; 115–159 for hypertension and heart failure; and 100–144 for sudden cardiac death. Assuming linear associations between 100 and 300 mg/dL, LDL-C was positively associated with CVD mortality [hazard ratio (HR) per 39-mg/dL (1-mmol/L) higher LDL-C = 1.10], largely due to ischaemic heart disease (HR = 1.26), followed by sudden cardiac death (HR = 1.13), ischaemic stroke (HR = 1.11) and heart failure (HR = 1.05). Intracerebral haemorrhage (HR = 0.90), but not subarachnoid haemorrhage, had inverse associations. Women and older adults had weaker positive associations than men and younger adults (Pinteraction < 0.001 for both sex and age). Individuals aged 75–84 years had modest positive associations with CVD mortality, especially ischaemic heart disease and ischaemic stroke.
Conclusion
LDL-C had U-curve associations for CVD mortality. The associations and optimal ranges differed across CVD subtypes. Women and older adults had weaker positive associations than men and younger adults. Positive associations with ischaemic heart disease and ischaemic stroke were maintained in adults aged 75–84 years.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Brain Ischemia</subject><subject>Cardiovascular Disease</subject><subject>Cardiovascular Diseases</subject><subject>Cerebral Hemorrhage</subject><subject>Cholesterol, LDL</subject><subject>Death, Sudden, Cardiac</subject><subject>Female</subject><subject>Heart Failure</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors</subject><subject>Ischemic Stroke</subject><subject>Male</subject><subject>Myocardial Ischemia</subject><subject>Prospective Studies</subject><subject>Republic of Korea - epidemiology</subject><subject>Risk Factors</subject><subject>Stroke - epidemiology</subject><issn>0300-5771</issn><issn>1464-3685</issn><issn>1464-3685</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kUuLFDEURoMoTju6ci9ZiSA1k1c94kIYBl844EbXIZXcsjOkkjJJ9dB_x19q2m4H3bi6i5yce_k-hJ5TckGJ5JfuFi7tXhvC5AO0oaITDe-G9iHaEE5I0_Y9PUNPcr4lhAoh5GN0xltGBy7EBv28yjkap4uLAY9Q7gAC9vGusRCyK3vs3RKXFAu4gM02esgFUvRYB4uNTtbFnc5m9TrhOaai_eFTZXOpzoBDDM2aIeU3WOPqyQuY4naATdxWvGKr_c1TcSHx7Lw_HPI5JtABa7v6kp-iR5P2GZ6d5jn69v7d1-uPzc2XD5-ur24aIygrTa9F2xIj2gGoGQbOZCvsaA3RQ9dL04txEoR3ExtZDUFroC2nLbF0Gtg4kImfo7dH77KOM1gDoSTt1ZLcrNNeRe3Uvy_BbdX3uFOylwOTrApenQQp_lhrUGp22YD3OkBcs2Id54OUXPCKvj6ipkaSE0z3ayhRh1ZVbVWdWq30i78vu2f_1FiBl0cgrst_Tb8Afu2xCw</recordid><startdate>20220810</startdate><enddate>20220810</enddate><creator>Yi, Sang-Wook</creator><creator>An, Sang Joon</creator><creator>Park, Hyung Bok</creator><creator>Yi, Jee-Jeon</creator><creator>Ohrr, Heechoul</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6656-6205</orcidid></search><sort><creationdate>20220810</creationdate><title>Association between low-density lipoprotein cholesterol and cardiovascular mortality in statin non-users: a prospective cohort study in 14.9 million Korean adults</title><author>Yi, Sang-Wook ; An, Sang Joon ; Park, Hyung Bok ; Yi, Jee-Jeon ; Ohrr, Heechoul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c412t-7a4550c458e1c8832954dbdc0a8679c74bf4036f2b2449aae153150d1f82b80f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Brain Ischemia</topic><topic>Cardiovascular Disease</topic><topic>Cardiovascular Diseases</topic><topic>Cerebral Hemorrhage</topic><topic>Cholesterol, LDL</topic><topic>Death, Sudden, Cardiac</topic><topic>Female</topic><topic>Heart Failure</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors</topic><topic>Ischemic Stroke</topic><topic>Male</topic><topic>Myocardial Ischemia</topic><topic>Prospective Studies</topic><topic>Republic of Korea - epidemiology</topic><topic>Risk Factors</topic><topic>Stroke - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yi, Sang-Wook</creatorcontrib><creatorcontrib>An, Sang Joon</creatorcontrib><creatorcontrib>Park, Hyung Bok</creatorcontrib><creatorcontrib>Yi, Jee-Jeon</creatorcontrib><creatorcontrib>Ohrr, Heechoul</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yi, Sang-Wook</au><au>An, Sang Joon</au><au>Park, Hyung Bok</au><au>Yi, Jee-Jeon</au><au>Ohrr, Heechoul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association between low-density lipoprotein cholesterol and cardiovascular mortality in statin non-users: a prospective cohort study in 14.9 million Korean adults</atitle><jtitle>International journal of epidemiology</jtitle><addtitle>Int J Epidemiol</addtitle><date>2022-08-10</date><risdate>2022</risdate><volume>51</volume><issue>4</issue><spage>1178</spage><epage>1189</epage><pages>1178-1189</pages><issn>0300-5771</issn><issn>1464-3685</issn><eissn>1464-3685</eissn><abstract>Abstract
Background
Limited information is available on detailed sex/age-specific associations between low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease (CVD) mortality and ‘the optimal range’ associated with the lowest CVD mortality in the general population.
Methods
Korean adults (N = 14 884 975) who received routine health screenings during 2009–2010 were followed until 2018 for CVD mortality.
Results
During 8.8 years (mean) of follow-up, 94 344 individuals died from CVD. LDL-C had U-curve associations with mortality from CVD and its subtypes, except haemorrhagic stroke. Optimal range was 90–149 mg/dL for CVD; 70–114 for ischaemic heart disease; 85–129 for ischaemic stroke; ≥85 for subarachnoid haemorrhage; ≥130 for intracerebral haemorrhage; 115–159 for hypertension and heart failure; and 100–144 for sudden cardiac death. Assuming linear associations between 100 and 300 mg/dL, LDL-C was positively associated with CVD mortality [hazard ratio (HR) per 39-mg/dL (1-mmol/L) higher LDL-C = 1.10], largely due to ischaemic heart disease (HR = 1.26), followed by sudden cardiac death (HR = 1.13), ischaemic stroke (HR = 1.11) and heart failure (HR = 1.05). Intracerebral haemorrhage (HR = 0.90), but not subarachnoid haemorrhage, had inverse associations. Women and older adults had weaker positive associations than men and younger adults (Pinteraction < 0.001 for both sex and age). Individuals aged 75–84 years had modest positive associations with CVD mortality, especially ischaemic heart disease and ischaemic stroke.
Conclusion
LDL-C had U-curve associations for CVD mortality. The associations and optimal ranges differed across CVD subtypes. Women and older adults had weaker positive associations than men and younger adults. Positive associations with ischaemic heart disease and ischaemic stroke were maintained in adults aged 75–84 years.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>35218344</pmid><doi>10.1093/ije/dyac029</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-6656-6205</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | International journal of epidemiology, 2022-08, Vol.51 (4), p.1178-1189 |
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| subjects | Aged Aged, 80 and over Brain Ischemia Cardiovascular Disease Cardiovascular Diseases Cerebral Hemorrhage Cholesterol, LDL Death, Sudden, Cardiac Female Heart Failure Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors Ischemic Stroke Male Myocardial Ischemia Prospective Studies Republic of Korea - epidemiology Risk Factors Stroke - epidemiology |
| title | Association between low-density lipoprotein cholesterol and cardiovascular mortality in statin non-users: a prospective cohort study in 14.9 million Korean adults |
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