High-Density Lipoprotein Cholesterol and All-Cause and Cause-Specific Mortality Among the Elderly

Li, Zhi-Hao; Lv, Yue; Zhong, Wen; Gao, Xiang; Kraus, Virginia B.; Zou, Meng Chen; Zhang, Xi Ru; Li, Fu Rong; Yuan, Jingya; Shi, Xiao Ming; Wu, Xian; Chen, Mao

doi:10.1210/jc.2018-02511

Cited by 39 publications

(42 citation statements)

References 30 publications

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“…They also observed a non-linear association of HDL-C with cardiovascular mortality. 31 In our study, the cut-off points of HDL-C were higher for all-cause mortality than cardiovascular mortality (66 vs 46 mg/dL), which were similar to Maoet al 31 Similar nature of non-linear associations (Ushaped or J-shaped) were also confirmed in some other studies. 18,19,32,33 These findings were inconsistent with studies that illustrated an inverse linear association between HDL-C and mortality.…”

Section: Discussionsupporting

confidence: 91%

“…20 Another study using data from the NHANES 1999-2010 showed that extremely high (≥100 mg/dL) or low (<30 mg/dL) levels increased risk of all-cause deaths and deaths from coronary heart disease and stroke in American adults, but the results were not stratified by hypertension status. 30 Among the elderly, Mao, et al 31 found that HDL-C <61 mg/dL was related to a 18% higher all-cause mortality risk and HDL-C >87 mg/dL increased the risk by 56% compared with the group with HDL-C concentrations ranging from 61 to 87 mg/dL. They also observed a non-linear association of HDL-C with cardiovascular mortality.…”

Section: Discussionmentioning

confidence: 99%

“…A cohort from northern rural China draw a U-shaped relationship between HDL-C concentrations and all-cause mortality in younger participants (<65 years old), but not in those >65 years, which was not in accordance with the results of the elderly. 17,31 Banach et al 4 found an HDL-C paradox in Mexican-American ethnicity participants, among which higher HDL-C levels had greater all-cause mortality risk compared with a lower level. Moreover, in patients with chronic renal insufficiency, lower risk of all-cause and cardiovascular mortality for HDL-C >60 mg/dL was only found in women.…”

Section: Discussionmentioning

confidence: 99%

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<p>U-Shaped Association of High-Density Lipoprotein Cholesterol with All-Cause and Cardiovascular Mortality in Hypertensive Population</p>

Chen¹,

Liu²,

Liu³

et al. 2020

RMHP

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Purpose: Whether the paradox of high-density lipoprotein cholesterol (HDL-C) and elevated mortality risk extends to hypertensive patients is unclear. We aimed to investigate the association between HDL-C and all-cause and cardiovascular disease mortality in adults with hypertension. Methods: In the National Health and Nutrition Examination Surveys, 11,497 hypertensive participants aged ≥18years old and examined at baseline between 1999 and 2014 were followed up until December 2015. We categorized the HDL-C concentration as ≤30, 31-40, 41-50, 51-60 (reference), 61-70, >70 mg/dL and examined their associations with all-cause and cardiovascular mortality, respectively. Multivariate Cox regression was used to calculated hazard ratio (HR) and 95% confidence interval (CI) for mortality risk. Results: During follow-up (median: 9.2 ± 3.8 years), 3012 deaths and 713 cardiovascular deaths were observed. In the restrictive cubic curves, associations of HDL-C levels and allcause and cardiovascular mortality were detected to be U-shaped. After multivariable adjustment, HRs for all-cause mortality were for the lowest HDL-C concentration (≤30 mg/dL) 1.29 (95% CI, 1.07-1.56) and the highest (>70 mg/dL) 1.20 (1.06-1.37), comparing with the reference group. For cardiovascular mortality, HRs were 1.31 (0.83-1.48) and 1.09 (0.83-1.43), respectively. Similar results were obtained in subgroups stratified by age, gender, race, and taking lipid-lowering drugs. The lowest all-cause mortality risk was observed at HDL-C 66 mg/dL (concentration) and 51-60 mg/dL (range). Conclusion: Both lower and higher HDL-C concentration appeared to be associated with higher mortality in hypertensive population. Further investigation is warranted to clarify the underlying mechanisms.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

<p>U-Shaped Association of High-Density Lipoprotein Cholesterol with All-Cause and Cardiovascular Mortality in Hypertensive Population</p>

Chen¹,

Liu²,

Liu³

et al. 2020

RMHP

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“…A slightly higher, though not statistically significant, risk for all-cause and cancer mortality was found in south Korean adults with HDL cholesterol levels > 85 mg/dL [6]. Increased allcause (HR = 1.56; 95% CI 1.08-2.26), CV (HR = 1.62; 0.86-3.05) and non-CV deaths (HR = 1.45; 0.93-2.27) were found in US elderly individuals with HDL cholesterol levels > 90 mg/dL [9]. In an American prospective study, high HDL cholesterol levels (80-100 mg/dL) were found to be associated with an increased risk for overall (RR = 1.25; 1.09-1.49), coronary heart disease (RR = 1.09; 1.02-1.32) and stroke (RR = 1.11; 1.02-1.32) mortalities [10].…”

Section: All-cause and Specific-cause Mortalitymentioning

confidence: 91%

“…Evidence from epidemiological studies has raised doubt about the protective role of high HDL cholesterol levels against CV disease (CVD) risk; intriguingly, U-shaped associations between HDL cholesterol concentrations and CVD risk and mortality have been reported [6][7][8][9][10][11]. The conformational and functional properties of HDL particles may be altered in individuals with extremely high HDL cholesterol and HDL functionality may be compromised such that those particles no longer function but rather cause harm [1].…”

mentioning

confidence: 99%

Is HDL cholesterol protective in patients with type 2 diabetes? A retrospective population-based cohort study

et al. 2020

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Background: The protective role of high HDL cholesterol levels against cardiovascular diseases has been recently questioned. Limited data are available on this specific topic in patients with type 2 diabetes mellitus (T2DM). We aimed to evaluate the association of HDL cholesterol concentrations with all-cause and cause-specific mortality in a historical cohort of T2DM patients with 14 years of follow-up. Methods: This is a retrospective population-based cohort study involving 2113 T2DM patients attending the Diabetic Clinic of Asti. Survival analyses were performed to assess hazard ratios for overall and specific-cause mortality by HDL cholesterol tertiles, using the middle HDL cholesterol tertile as a reference. Results: The mean age was 66 ± 11 years; 51.4% of patients had low HDL-cholesterol levels. After a 14-year follow-up, 973/2112 patients had died (46.1%). The HDL cholesterol tertile cutoff points were 37.5 and 47.5 mg/dL (males) and 41.5 and 52.0 mg/dL (females). No associations between lower and upper HDL cholesterol tertiles respectively and all-cause (HR = 1.12; 95% CI 0.96-1.32; HR = 1.11; 0.95-1.30), cardiovascular (HR = 0.97; 0.77-1.23; HR = 0.94; 0.75-1.18) or cancer (HR = 0.92; 0.67-1.25; HR = 0.89; 0.66-1.21) mortality were found. A significantly increased risk for infectious disease death was found both in the lower (HR = 2.62; 1.44-4.74) and the upper HDL-cholesterol tertiles (HR = 2.05; 1.09-3.85) when compared to the reference. Individuals in the upper tertile showed an increased risk for mortality due to diabetes-related causes (HR = 1.87; 1.10-3.15). Conclusions: Our results corroborate the hypothesis that HDL cholesterol levels are nonprotective in T2DM patients. The U-shaped association between HDL-cholesterol levels and mortality associated with infectious diseases should be verified by further studies.

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Sex-dependent associations of plasma high-density lipoprotein cholesterol and mortality risk in healthy older men and women: two prospective cohort studies

Hussain,

Tonkin,

Watts

et al. 2023

GeroScience

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The relationship between high plasma high-density lipoprotein cholesterol (HDL-C) and cause and mortality are not well established in healthy older people. This study examined the associations between HDL-C levels and mortality in initially healthy older men and women. This analysis included participants from the Aspirin in Reducing Events in the Elderly (ASPREE; n=18,668) trial and a matched cohort from the UK Biobank (UKB; n=62,849 ≥65 years). Cox regression was used to examine hazard ratios between HDL-C categories <1.03 mmol/L, 1.03–1.55 mmol/L (referent category), 1.55–2.07 mmol/L, and >2.07 mmol/L and all-cause, cancer, cardiovascular disease (CVD), and “non-cancer non-CVD” mortality. Genetic contributions were assessed using a polygenic score for HDL-C. Among ASPREE participants (aged 75±5 years), 1836 deaths occurred over a mean follow-up of 6.3±1.8 years. In men, the highest category of HDL-C levels was associated with increased risk of all-cause (HR 1.60, 95% CI 1.26–2.03), cancer (HR 1.37, 95% CI 0.96–2.00), and “non-cancer non-CVD” mortality (HR 2.35, 95% CI 1.41–3.42) but not CVD mortality (HR 1.08, 95% CI 0.60–1.94). The associations were replicated among UKB participants (aged 66.9±1.5 years), including 8739 deaths over a mean follow-up of 12.7±0.8 years. There was a non-linear association between HDL-C levels and all-cause and cause-specific mortality. The association between HDL-C levels and mortality was unrelated to variations in the HDL-C polygenic score. No significant association was found between HDL-C levels and mortality in women. Higher HDL-C levels are associated with increased risk from cancer and “non-cancer non-CVD” mortality in healthy older men but no such relationship was observed in women.

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High-Density Lipoprotein Cholesterol and All-Cause and Cause-Specific Mortality Among the Elderly

Cited by 39 publications

References 30 publications

<p>U-Shaped Association of High-Density Lipoprotein Cholesterol with All-Cause and Cardiovascular Mortality in Hypertensive Population</p>

<p>U-Shaped Association of High-Density Lipoprotein Cholesterol with All-Cause and Cardiovascular Mortality in Hypertensive Population</p>

Is HDL cholesterol protective in patients with type 2 diabetes? A retrospective population-based cohort study

Sex-dependent associations of plasma high-density lipoprotein cholesterol and mortality risk in healthy older men and women: two prospective cohort studies

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