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. 2024 Jun 18;24(1):1624.
doi: 10.1186/s12889-024-19164-8.

U-shaped relationship between non-high-density lipoprotein cholesterol and cognitive impairment in Chinese middle-aged and elderly: a cross-sectional study

Lei Li #  1 , Lingdan Zhuang #  1 , Zichen Xu #  1 , Luqing Jiang  1 , Ying Zhai  1 , Daoqin Liu  2 , Qiwen Wu  3
Affiliations

U-shaped relationship between non-high-density lipoprotein cholesterol and cognitive impairment in Chinese middle-aged and elderly: a cross-sectional study

Lei Li et al. BMC Public Health. .

Abstract

Background: The relationship between blood lipids and cognitive function has long been a subject of interest, and the association between serum non-high-density lipoprotein cholesterol (non-HDL-C) levels and cognitive impairment remains contentious.

Methods: We utilized data from the 2011 CHARLS national baseline survey, which after screening, included a final sample of 10,982 participants. Cognitive function was assessed using tests of episodic memory and cognitive intactness. We used multiple logistic regression models to estimate the relationship between non-HDL-C and cognitive impairment. Subsequently, utilizing regression analysis results from fully adjusted models, we explored the nonlinear relationship between non-HDL-C as well as cognitive impairment using smooth curve fitting and sought potential inflection points through saturation threshold effect analysis.

Results: The results showed that each unit increase in non-HDL-C levels was associated with a 5.5% reduction in the odds of cognitive impairment (OR = 0.945, 95% CI: 0.897-0.996; p < 0.05). When non-HDL-C was used as a categorical variable, the results showed that or each unit increase in non-HDL-C levels, the odds of cognitive impairment were reduced by 14.2%, 20.9%, and 24% in the Q2, Q3, and Q4 groups, respectively, compared with Q1. In addition, in the fully adjusted model, analysis of the potential nonlinear relationship by smoothed curve fitting and saturation threshold effects revealed a U-shaped relationship between non-HDL-C and the risk of cognitive impairment, with an inflection point of 4.83. Before the inflection point, each unit increase in non-HDL-C levels was associated with a 12.3% decrease in the odds of cognitive impairment. After the tipping point, each unit increase in non-HDL-C levels was associated with an 18.8% increase in the odds of cognitive impairment (All p < 0.05).

Conclusion: There exists a U-shaped relationship between non-HDL-C and the risk of cognitive impairment in Chinese middle-aged and elderly individuals, with statistical significance on both sides of the turning points. This suggests that both lower and higher levels of serum non-high-density lipoprotein cholesterol increase the risk of cognitive impairment in middle-aged and elderly individuals.

Keywords: CHARLS; Cognitive impairment; Non-HDL-C; U-shaped relationship.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Participant selection process flowchart
Fig. 2
Fig. 2
The smoothing curve fitting was used to assess the nonlinear relationship between non-HDL-C and cognitive impairment
Fig. 3
Fig. 3
The effect size of non-HDL-C on cognitive impairment in the subgroup. Notes: adjusted for age, gender, BMI, education, marital status, Hypertension, Diabetes, Dyslipidemia, Depression, Antihypertensive therapy, Hypoglycemic therapy, Lipid medication, smoking, drinking, Exercise, and Socializing
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