Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.
Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, Beijing, China.
J Clin Endocrinol Metab. 2019 Aug 1;104(8):3370-3378. doi: 10.1210/jc.2018-02511.
The patterns of the association between high-density lipoprotein cholesterol (HDL-C) concentrations and mortality among the elderly are still unclear.
To examine the association of HDL-C concentrations with mortality and to identify the optimal HDL-C concentration range that predicts the lowest risk of all-cause mortality among the elderly.
This was a nationwide, community-based, prospective cohort study.
This study included 7766 elderly individuals (aged ≥65 years; mean age: 74.4 years) from the Health and Retirement Study. Cox proportional hazards models and Cox models with penalized smoothing splines were used to estimate hazard ratios (HRs) with 95% CI for all-cause and cause-specific mortality.
During a median follow-up of 5.9 years, 1921 deaths occurred. After a full adjustment for covariates, a nonlinear (P < 0.001 for nonlinearity) association was found between HDL-C and all-cause mortality [minimum mortality risk at 71 mg/dL (1.84 mM)]; the risk for all-cause mortality was significantly higher in the groups with HDL-C concentration <61 mg/dL (1.58 mM; HR: 1.18; 95% CI: 1.05 to 1.33) and with HDL-C concentration >87 mg/dL (2.25 mM; HR: 1.56; 95% CI: 1.17 to 2.07) than in the group with HDL-C concentrations ranging from 61 to 87 mg/dL (1.58 to 2.25 mM). Nonlinear associations of HDL-C concentrations with both cardiovascular and noncardiovascular mortality were also observed (both P < 0.001 for nonlinearity).
Among the elderly, nonlinear associations were found between HDL-C and all-cause and cardiovascular mortality. The single optimal HDL-C concentration and range were 71 mg/dL and 61 to 87 mg/dL, respectively.
高密度脂蛋白胆固醇（HDL-C）浓度与老年人死亡率之间的关联模式仍不清楚。
研究 HDL-C 浓度与死亡率的关系，并确定预测老年人全因死亡率风险最低的最佳 HDL-C 浓度范围。
这是一项全国性的、基于社区的前瞻性队列研究。
本研究纳入了来自健康与退休研究的 7766 名老年人（年龄≥65 岁；平均年龄：74.4 岁）。使用 Cox 比例风险模型和带有惩罚平滑样条的 Cox 模型来估计全因和特定原因死亡率的风险比（HR）及其 95%置信区间。
在中位随访 5.9 年期间，发生了 1921 例死亡。在对所有协变量进行充分调整后，发现 HDL-C 与全因死亡率之间存在非线性关系（非线性 P<0.001）[最低死亡率风险在 71mg/dL（1.84mM）]；HDL-C 浓度<61mg/dL（1.58mM；HR：1.18；95%CI：1.05 至 1.33）和 HDL-C 浓度>87mg/dL（2.25mM；HR：1.56；95%CI：1.17 至 2.07）组的全因死亡率风险显著高于 HDL-C 浓度在 61 至 87mg/dL（1.58 至 2.25mM）的组。还观察到 HDL-C 浓度与心血管和非心血管死亡率之间的非线性关联（非线性均 P<0.001）。
在老年人中，发现 HDL-C 与全因和心血管死亡率之间存在非线性关联。单个最佳 HDL-C 浓度和范围分别为 71mg/dL 和 61 至 87mg/dL。
