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. 2023 Feb 8:10:1065750.
doi: 10.3389/fcvm.2023.1065750. eCollection 2023.

The U-shaped association of non-high-density lipoprotein cholesterol with all-cause and cardiovascular mortality in general adult population

Yu Huang  1   2 , Meng Qi Yan  2 , Dan Zhou  2 , Chao Lei Chen  2 , Ying Qing Feng  1   2
Affiliations

The U-shaped association of non-high-density lipoprotein cholesterol with all-cause and cardiovascular mortality in general adult population

Yu Huang et al. Front Cardiovasc Med. .

Abstract

Background: 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.

Methods: 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.

Results: 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/m2.

Conclusion: Our findings suggest a U-shaped association between non-HDL-C and mortality among adult population.

Keywords: U-shaped; adult population; all-cause mortality; cardiovascular mortality; non-high-density lipoprotein cholesterol.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study cohort.
Figure 2
Figure 2
Spline analyzes of all-cause (A) and cardiovascular (B) mortality by non-HDL-C in the overall cohort (Spline analyzes were adjusted for age, gender, race, smoking, family income, education level, physical activity, body mass index, systolic blood pressure, estimated glomerular filtration rate, comorbidities (diabetes and hypertension), and medicine use (antihypertensive drugs, hypoglycemic agents, and lipid-lowering drugs.
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