Huang Yu, Yan Meng Qi, Zhou Dan, Chen Chao Lei, Feng Ying Qing
School of Medicine, South China University of Technology, Guangzhou, China.
Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Front Cardiovasc Med. 2023 Feb 8;10:1065750. doi: 10.3389/fcvm.2023.1065750. eCollection 2023.
Non-high-density lipoprotein cholesterol (non-HDL-C) has been associated with atherosclerosis. However, the association between non-HDL-C and mortality in adult population remains unclear. We intended to investigate the association of non-HDL-C with cardiovascular and all-cause mortality using national representative data.
The study included 32,405 participants from the National Health and Nutrition Examination Survey (1999-2014). Mortality outcomes were ascertained by linkage to National Death Index records through December 31, 2015. Multivariable-adjusted Cox regression models were used to evaluate hazard ratio (HR) and 95% confidence interval (CI) of non-HDL-C concentrations in quintiles. Two-piecewise linear regression and restricted cubic spline analyzes were performed to test dose-response associations.
After a median follow-up of 98.40 months, 2,859 (8.82%) all-cause and 551 (1.70%) cardiovascular deaths occurred. Compared with the highest group, the multivariable-adjusted hazard ratio (HR) of the first quintile for all-cause mortality was 1.53 (95%CI, 1.35-1.74). Higher non-HDL-C above a cutoff value of 4.9 mmol/L was related with cardiovascular mortality (HR = 1.33, 95%CI, 1.13-1.57). A U-shaped relationship between non-HDL-C and all-cause mortality was found in spline analysis with a cutoff value around 4 mmol/L. Similar results in subgroups analyzes were found among male, non-white population, participants who were not taking lipid-lowering drugs, and with body mass index (BMI) <25 kg/m.
Our findings suggest a U-shaped association between non-HDL-C and mortality among adult population.
非高密度脂蛋白胆固醇（non-HDL-C）与动脉粥样硬化有关。然而，non-HDL-C与成年人群死亡率之间的关联仍不清楚。我们旨在利用全国代表性数据研究non-HDL-C与心血管疾病及全因死亡率之间的关联。
该研究纳入了来自国家健康与营养检查调查（1999 - 2014年）的32405名参与者。通过与截至2015年12月31日的国家死亡指数记录进行关联来确定死亡结局。采用多变量调整的Cox回归模型评估五分位数中non-HDL-C浓度的风险比（HR）和95%置信区间（CI）。进行了两段式线性回归和受限立方样条分析以检验剂量反应关联。
在中位随访98.40个月后，发生了2859例（8.82%）全因死亡和551例（1.70%）心血管疾病死亡。与最高组相比，第一五分位数的全因死亡率的多变量调整风险比（HR）为1.53（95%CI，1.35 - 1.74）。非HDL-C高于4.9 mmol/L的临界值与心血管疾病死亡率相关（HR = 1.33，95%CI，1.13 - 1.57）。在样条分析中发现non-HDL-C与全因死亡率之间呈U形关系，临界值约为4 mmol/L。在男性、非白人人群、未服用降脂药物的参与者以及体重指数（BMI）<25 kg/m²的亚组分析中也发现了类似结果。
我们的研究结果表明，成年人群中non-HDL-C与死亡率之间呈U形关联。
