Association between low density lipoprotein cholesterol and all-cause mortality: results from the NHANES 1999–2014

Liu, Ya; Liu, Fubin; Zhang, Liwen; Li, Junxian; Kang, Wenjuan; Cao, Mingcui; Song, Fang; Song, Fengju

doi:10.1038/s41598-021-01738-w

Cited by 18 publications

(10 citation statements)

References 38 publications

(24 reference statements)

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“…There are a few general population-based studies that compare LDL-C levels and mortality risk between sexes. Both NHANES 1994-2014 data from the US ( Liu et al., 2021a ; Liu et al., 2021b ) and the Ibaraki Prefecture Health Study of Japan ( Noda et al, 2010 ) found that the lowest levels of LDL-C (<70 and <80 mg/dL, respectively) increased all-cause mortality risk in both men and women similar to the results of our study. In the Japanese study above ( Noda et al, 2010 ), higher, but not lower concentrations of LDL-C were associated with increased mortality risk from coronary heart disease for men, but not for women.…”

Section: Discussionsupporting

confidence: 86%

“…Each year’s lowest albumin and Hb were collected to calculate the mean of the annual mean of each to prevent overestimation of those values after replacement. Mean albumin levels were grouped into ≥3.5, 3.0−3.4, 2.5−2.9, and <2.5 g/dL ( Liu et al., 2021a ; Liu et al., 2021b ). Hypoglycemia was identified in patients with fasting or postprandial plasma or POC glucose values <70 mg/dL on any occasion during the study period ( Draznin et al, 2022 ).…”

Section: Methodsmentioning

confidence: 99%

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The relationship of low-density lipoprotein cholesterol and all-cause or cardiovascular mortality in patients with type 2 diabetes: a retrospective study

Chang

Yeh

Ooi

et al. 2023

PeerJ

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Background The optimal levels of low-density lipoprotein cholesterol (LDL-C) in patients with type 2 diabetes (T2D) are not currently clear. In this study, we determined the relationship between various mean LDL-C and all-cause or cardiovascular mortality risks in patients with T2D, stratifying by albumin level, age, sex, and antilipid medication use. We also evaluated the association of LDL-C standard deviation (LDL-C-SD) and all-cause and cardiovascular mortality by type of antilipid medication use. Methods A total of 46,675 T2D patients with a prescription for antidiabetic agents >6 months from outpatient visits (2003–2018) were linked to Taiwan’s National Death Registry to identify all-cause and cardiovascular mortality. The Poisson assumption was used to estimate mortality rates, and the Cox proportional hazard regression model was used to assess the relative hazards of respective mortality in relation to mean LDL-C in patient cohorts by albumin level, age, sex, and antilipid use adjusting for medications, comorbidities, and laboratory results. We also determined the overall, and anti-lipid-specific mortality rates and relative hazards of all-cause and cardiovascular mortality associated with LDL-C-SD using the Poisson assumption and Cox proportional hazard regression model, respectively. Results All-cause and cardiovascular mortality rates were the lowest in T2D patients with a mean LDL-C > 90-103.59 mg/dL in the normal albumin group (≥ 3.5 g/dL). Compared to T2D patients with a mean LDL-C > 90–103.59 mg/dL, those with a mean LDL-C ≤ 77 mg/dL had an elevated risk of all-cause mortality in both the normal and lower albumin groups. T2D patients with a mean LDL-C ≤ 90 and > 103.59–119 mg/dL had relatively higher risk of cardiovascular mortality in the normal albumin group, but in the lower albumin group (<3.5 g/dL), any level of mean LDL-C ≤ 119 mg/dL was not significantly associated with cardiovascular mortality. Increased risks of all-cause and cardiovascular mortality were observed in patients with a mean LDL-C ≤ 77 mg/dL in both sexes and in all age groups except in those aged <50 years, a lower mean LDL-C was not associated with cardiovascular mortality. Similarly, patients with an LDL-C-SD <10th and > 90th percentiles were associated with significant risks of all-cause and cardiovascular mortality. In statin users, but not fibrate users, lower and higher levels of mean LDL-C and LDL-C-SD were both associated with elevated risks of all-cause and cardiovascular mortality. Conclusions The optimal level of LDL-C was found to be >90–103.59 mg/dL in T2D patients. Lower and higher levels of mean LDL-C and LDL-C-SD were associated with all-cause and cardiovascular mortality, revealing U-shaped associations. Further studies are necessary to validate the relationship between optimal LDL-C levels and all-cause and cardiovascular mortality in patients with diabetes.

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Section: Discussionsupporting

confidence: 86%

Section: Methodsmentioning

confidence: 99%

The relationship of low-density lipoprotein cholesterol and all-cause or cardiovascular mortality in patients with type 2 diabetes: a retrospective study

Chang

Yeh

Ooi

et al. 2023

PeerJ

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“…Plasma cholesterol levels were measured on participants who were examined in the morning. Serum LDL-C levels were calculated from directly measured values of total cholesterol, triglycerides, and high-density lipoprotein cholesterol (HDL-C) in accordance with Friedewald's calculation formula: [LDL-C] = [total cholesterol] – [HDL-C] – [triglycerides/5] ( 12 ). The dependent variable was the lumbar BMD, which was measured by the dual-energy X-ray bone densitometer.…”

Section: Methodsmentioning

confidence: 99%

Inverse association between low-density lipoprotein cholesterol and bone mineral density in young- and middle-aged people: The NHANES 2011–2018

et al. 2022

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ObjectivesLow-density lipoprotein cholesterol (LDL-C) plays an essential part in bone metabolism. However, the correlation between LDL-C levels and bone mineral density (BMD) is still controversial. This study aimed to explore the relationship between LDL-C levels and lumbar BMD in young- and middle-aged people.MethodsWe conducted a cross-sectional study comprising 4,441 participants aged 20–59 from the National Health and Nutrition Examination Survey (NHANES). LDL-C levels and lumbar BMD were used as independent and dependent variables, respectively. We evaluated the correlation between LDL-C levels and lumbar BMD through a weighted multivariate linear regression model. We performed a subgroup analysis of the relationship between LDL-C levels and lumbar BMD based on age, gender, and body mass index (BMI).ResultsAfter adjusting for confounding factors, LDL-C levels were negatively correlated with lumbar BMD. In subgroup analyses stratified by gender, this negative association was statistically significant in men and women. In the subgroup analysis stratified by age, a negative connection existed in people aged 30–49 years. In the subgroup analysis divided by BMI, there was an inverse correlation in overweight people (25 ≤ BMI < 30).ConclusionsOur research observed an inverse association between LDL-C levels and lumbar BMD in young- and middle-aged people, especially in people aged 30–49 years and who are overweight. Close monitoring of BMD and early intervention may be required for these people.

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“…2/434; hazard ratio [HR]: 2.52, 95% confidence interval [CI]: 0.49–12.97) despite 47.7% of the evolocumab group and 18.4% in statin-alone group achieving an LDL-C goal of ≤55 mg/dL. Note that recent population-based cohort studies from Denmark, [ 27 ] Korea, [ 28 ] China, [ 29 ] and US [ 30 ] demonstrated a U-shaped association between baseline LDL-C levels and all-cause mortality. As the optimal goal of lipid-lowering as a lifelong approach is improving health, longevity and well-being should always be a top priority.…”

Section: Aggressive Lipid-lowering and Cardiovascular And All-cause M...mentioning

confidence: 99%

Antithrombotic therapy and bleeding risk in the era of aggressive lipid-lowering: current evidence, clinical implications, and future perspectives

Zhou

Liu

et al. 2023

Chinese Medical Journal

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The clinical efficacy of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in reducing major cardiovascular adverse events related to atherosclerotic cardiovascular disease (ASCVD) has been well established in recent large randomized outcome trials. Although the cardiovascular and all-cause mortality benefit of PCSK9i remains inconclusive, current cholesterol management guidelines have been modified toward more aggressive goals for lowering low-density lipoprotein cholesterol (LDL-C). Consequently, the emerging concept of “the lower the better” has become the paradigm of ASCVD prevention. However, there is evidence from observational studies of a U-shaped association between baseline LDL-C levels and all-cause mortality in population-based cohorts. Among East Asian populations, low LDL-C was associated with an increased risk for hemorrhagic stroke in patients not on antithrombotic therapy. Accumulating evidence showed that low LDL-C was associated with an enhanced bleeding risk in patients on dual antiplatelet therapy following percutaneous coronary intervention. Additionally, low LDL-C was associated with a higher risk for incident atrial fibrillation and thereby, a possible increase in the risk for intracranial hemorrhage after initiation of anticoagulation therapy. The mechanism of low-LDL-C-related bleeding risk has not been fully elucidated. This review summarizes recent evidence of low-LDL-C-related bleeding risk in patients on antithrombotic therapy and discusses potential measures for reducing this risk, underscoring the importance of carefully weighing the pros and cons of aggressive LDL-C lowering in patients on antithrombotic therapy.

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Association between low density lipoprotein cholesterol and all-cause mortality: results from the NHANES 1999–2014

Cited by 18 publications

References 38 publications

The relationship of low-density lipoprotein cholesterol and all-cause or cardiovascular mortality in patients with type 2 diabetes: a retrospective study

The relationship of low-density lipoprotein cholesterol and all-cause or cardiovascular mortality in patients with type 2 diabetes: a retrospective study

Inverse association between low-density lipoprotein cholesterol and bone mineral density in young- and middle-aged people: The NHANES 2011–2018

Antithrombotic therapy and bleeding risk in the era of aggressive lipid-lowering: current evidence, clinical implications, and future perspectives

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