Wu Wanqing, Xiao Zhenxu, Liang Xiaoniu, Zhao Qianhua, Luo Jianfeng, Ding Ding
Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Front Med (Lausanne). 2022 Mar 8;9:783618. doi: 10.3389/fmed.2022.783618. eCollection 2022.
The relationship between serum cholesterol and mortality remains disputed. This study aimed to examine the association of low and high-density lipoprotein cholesterol (LDL-C and HDL-C) with all-cause mortality among community-dwelling older adults in the Shanghai Aging Study.
We followed 3,239 participants free of lipid-lowering agents for a median of 10 years. Levels of LDL-C and HDL-C were measured at baseline using fasting blood samples. Survival status was confirmed by the local mortality surveillance system. The associations between the levels of LDL-C, HDL-C, and all-cause mortality were assessed by Cox proportional hazards models.
The increment of LDL-C concentration was related to a lower risk of mortality ( for trend < 0.05). Using the highest quintile of LDL-C (≥4.10 mmol/L) as a reference, the lowest quintile of LDL-C (<2.61 mmol/L) was associated with the highest risk of mortality, after adjusting for confounders (HR 1.67; 95% CI 1.26-2.21), exclusion of death within the first 2 years of follow-up (HR 1.57; 95% CI 1.17-2.11), and exclusion of functionally impaired participants (HR 1.46; 95% CI 1.07-2.00). A U-shape relationship was found between HDL-C level and the mortality risk. Using the third quintile of HDL-C (1.21-1.39 mmol/L) as a reference, HR (95% CI) was 1.46 (1.09-1.95) for the lowest quintile (<1.09 mmol/L) and 1.45 (1.07-1.96) for the highest quintile (≥1.61 mmol/L) of HDL-C, after adjusting for confounders; and 1.57 (1.15-2.15) for the lowest quintile and 1.45 (1.04-2.01) for the highest quintile of HDL-C, after exclusion of death within the first 2 years of follow-up; and 1.55 (1.11-2.16) for the lowest quintile and 1.42 (1.00-2.02) for the highest quintile of HDL-C, after exclusion of functionally impaired participants.
We found an inverse association of LDL-C and a U-shape relationship of HDL-C with long-term all-cause mortality in a cohort with community-dwelling older Chinese adults. Levels of LDL-C and HDL-C are suggested to be managed properly in late life.
血清胆固醇与死亡率之间的关系仍存在争议。本研究旨在探讨上海老龄化研究中社区居住的老年人中低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）与全因死亡率之间的关联。
我们对3239名未使用降脂药物的参与者进行了为期10年的随访。在基线时使用空腹血样测量LDL-C和HDL-C水平。通过当地死亡率监测系统确认生存状态。采用Cox比例风险模型评估LDL-C、HDL-C水平与全因死亡率之间的关联。
LDL-C浓度的升高与较低的死亡风险相关（趋势P<0.05）。以LDL-C最高五分位数（≥4.10 mmol/L）为参照，在调整混杂因素后，LDL-C最低五分位数（<2.61 mmol/L）与最高死亡风险相关（HR 1.67；95%CI 1.26-2.21）；排除随访前2年内的死亡情况后（HR 1.57；95%CI 1.17-2.11）；排除功能受损参与者后（HR 1.46；95%CI 1.07-2.00）。HDL-C水平与死亡风险之间呈U形关系。以HDL-C第三五分位数（1.21-1.39 mmol/L）为参照，在调整混杂因素后，HDL-C最低五分位数（<1.09 mmol/L）的HR（95%CI）为1.46（1.09-1.95），最高五分位数（≥1.61 mmol/L）的HR为1.45（1.07-1.96）；排除随访前2年内的死亡情况后，HDL-C最低五分位数的HR为1.57（1.15-2.15），最高五分位数的HR为1.45（1.04-2.01）；排除功能受损参与者后，HDL-C最低五分位数的HR为1.55（1.11-2.16），最高五分位数的HR为1.42（1.00-2.02）。
我们在中国社区居住的老年人群队列中发现，LDL-C与长期全因死亡率呈负相关，HDL-C与长期全因死亡率呈U形关系。建议在老年期合理管理LDL-C和HDL-C水平。
