Department of Geriatrics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia.
Clin Nutr. 2024 Oct;43(10):2289-2295. doi: 10.1016/j.clnu.2024.08.017. Epub 2024 Aug 22.
Recent studies have demonstrated that very high high-density lipoprotein cholesterol (HDL-C) level was paradoxically linked with higher risk of cardiovascular mortality, all-cause mortality, and several age-related diseases. However, whether very high HDL-C level is associated with a higher risk of sarcopenia in older adults remains unclear. We aimed to investigate the association between HDL-C level and the risk of developing sarcopenia and low grip strength over time in older adults.
Participants were from the ongoing China Health and Retirement Longitudinal Study (CHARLS), which includes a nationally representative sample of adults aged ≥45 years and was performed from 2011 to 2020 with follow-ups every two to three years. The current study included 4031 participants aged ≥60 years. Muscle health-related data were collected in waves 2011, 2013, and 2015. Based on HDL-C level at baseline, participants were categorized into five groups: <35 mg/dl, 35-40 mg/dl, 40-60 mg/dl, 60-70 mg/dl and >70 mg/dl. The main outcomes were incident sarcopenia and incident low grip strength over follow-up. Low grip strength and sarcopenia were defined according to the 2019 Consensus by the Asian Working Group for Sarcopenia. Cox proportional-hazard regression was performed to investigate the association between HDL-C level and the risk of developing sarcopenia and low grip strength in older adults.
The mean age of study sample was 67.3 (SD 6.1) years, and 49.6% were male. During an average 3.7-year follow-up, 409 (10.1%) participants developed sarcopenia and 771 (21.1%) developed low grip strength. Non-linear association was observed between HDL-C level and the hazard of developing sarcopenia and low grip strength. The multivariable model showed that compared to the reference group (40-60 mg/dl), older adults with very high HDL-C level (>70 mg/dl) had a significantly higher risk of developing sarcopenia (HR 1.69, 95% CI 1.28-2.23) and low grip strength (HR 1.23 95% CI 1.00-1.51). Stratified analyses by sex revealed similar association.
We present the first longitudinal evidence that very high HDL-C level was associated with a significantly higher risk of muscle strength decline and developing sarcopenia in older adults. It is essential to monitor the muscle health of older adults with very high HDL-C level in clinical practice.
最近的研究表明，极高的高密度脂蛋白胆固醇（HDL-C）水平与心血管死亡率、全因死亡率和几种与年龄相关的疾病的风险增加呈矛盾关系。然而，极高的 HDL-C 水平是否与老年人的肌肉减少症风险增加有关仍不清楚。我们旨在研究 HDL-C 水平与老年人随时间发生肌肉减少症和握力下降风险之间的关系。
参与者来自正在进行的中国健康与退休纵向研究（CHARLS），该研究包括一个全国代表性的 45 岁及以上成年人样本，于 2011 年至 2020 年进行，每两年至三年进行一次随访。本研究纳入了 4031 名 60 岁及以上的参与者。在 2011 年、2013 年和 2015 年的波次中收集了与肌肉健康相关的数据。根据基线时的 HDL-C 水平，参与者被分为五组：<35mg/dl、35-40mg/dl、40-60mg/dl、60-70mg/dl 和>70mg/dl。主要结局是随访期间发生的肌肉减少症和握力下降事件。握力下降和肌肉减少症根据 2019 年亚洲肌肉减少症工作组的共识定义。采用 Cox 比例风险回归模型研究 HDL-C 水平与老年人发生肌肉减少症和握力下降风险之间的关系。
研究样本的平均年龄为 67.3（标准差 6.1）岁，49.6%为男性。在平均 3.7 年的随访期间，409 名（10.1%）参与者发生了肌肉减少症，771 名（21.1%）发生了握力下降。HDL-C 水平与发生肌肉减少症和握力下降的风险之间存在非线性关系。多变量模型显示，与参考组（40-60mg/dl）相比，HDL-C 水平极高（>70mg/dl）的老年人发生肌肉减少症的风险显著增加（HR 1.69，95%CI 1.28-2.23）和握力下降（HR 1.23，95%CI 1.00-1.51）。按性别分层分析显示出相似的关联。
本研究首次提供了纵向证据，表明极高的 HDL-C 水平与老年人肌肉力量下降和肌肉减少症的风险显著增加有关。在临床实践中，监测 HDL-C 水平极高的老年人的肌肉健康至关重要。
