Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
Department of Pathology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
Atherosclerosis. 2019 Apr;283:43-51. doi: 10.1016/j.atherosclerosis.2019.01.035. Epub 2019 Feb 5.
Our study aimed to investigate the association between high-density lipoprotein cholesterol (HDL-C) and all-cause and cause-specific mortality in Korean adults.
A total of 365,457 participants aged ≥40 years were selected from the Korean National Health Insurance Service-National Sample Cohort from 2009 to 2015. HDL-C level was categorized into <1.0, 1.0-1.19, 1.2-1.39, 1.4-1.59, 1.6-1.79 (reference), 1.8-1.99, 2.0-2.19 and ≥ 2.20 mmol/L. Cox proportional hazard models were used to examine the association between HDL-C level and mortality risk.
In a median 3.5-year follow-up period, 9,350 participants (2.6%) died. Men with HDL-C level of 1.6-1.79 mmol/L and women with HDL-C level of 1.4-1.59 mmol/L had the lowest age-standardized mortality rates for all-cause death. However, for cardiovascular death, men with HDL-C level ≥2.20 mmol/L and women with HDL-C level of 1.8-1.99 mmol/L showed the lowest mortality rate. After adjusting for multiple covariates, the hazard ratios for all-cause and cancer deaths showed a U-shaped relationship with HDL-C level for both sexes. However, there were heterogenetic associations between HDL-C level and mortality risk of subtypes of cardiovascular disease by sex. For other causes of death except for cardiovascular and cancer death, elevated mortality risk was mainly due to external causes (ICD-10 code, S00-T98).
In South Korea, very high HDL-C level was associated with increased risk of all-cause death. However, the increased all-cause mortality risk in people with very high HDL-C level was partly due to mortality risk from external causes.
本研究旨在探讨高密度脂蛋白胆固醇（HDL-C）与韩国成年人全因和死因特异性死亡率之间的关系。
我们从 2009 年至 2015 年的韩国国家健康保险服务-国家样本队列中选择了 365457 名年龄≥40 岁的参与者。HDL-C 水平分为<1.0、1.0-1.19、1.2-1.39、1.4-1.59、1.6-1.79（参考）、1.8-1.99、2.0-2.19 和≥2.20mmol/L。使用 Cox 比例风险模型来检验 HDL-C 水平与死亡率风险之间的关系。
在中位 3.5 年的随访期间，有 9350 名参与者（2.6%）死亡。男性 HDL-C 水平为 1.6-1.79mmol/L，女性 HDL-C 水平为 1.4-1.59mmol/L 的年龄标准化全因死亡率最低。然而，对于心血管疾病死亡，男性 HDL-C 水平≥2.20mmol/L，女性 HDL-C 水平为 1.8-1.99mmol/L 的死亡率最低。在调整了多个协变量后，全因和癌症死亡的风险比与男女两性的 HDL-C 水平呈 U 形关系。然而，HDL-C 水平与心血管疾病亚型的死亡率风险之间存在性别异质性关联。对于除心血管疾病和癌症死亡以外的其他死因，死亡率升高的主要原因是外部原因（ICD-10 编码，S00-T98）。
在韩国，极高的 HDL-C 水平与全因死亡风险增加有关。然而，极高 HDL-C 水平人群的全因死亡风险增加部分归因于外部原因导致的死亡风险。
