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. 2025 Oct 26:27:200537.
doi: 10.1016/j.ijcrp.2025.200537. eCollection 2025 Dec.

Age-stratified optimal non-HDL cholesterol and all-cause mortality in a healthy Taiwanese population considering personal risk factors

Edy Kornelius  1   2 , Tsuey-Hwa Hu  3 , Chih-Hua Chiao  4 , Jing-Shiang Hwang  3 , Ta-Chien Chan  5   6   7   8
Affiliations

Age-stratified optimal non-HDL cholesterol and all-cause mortality in a healthy Taiwanese population considering personal risk factors

Edy Kornelius et al. Int J Cardiol Cardiovasc Risk Prev. .

Abstract

Background: Non-high-density lipoprotein cholesterol (non-HDL-C) is a key cardiovascular risk factor, yet its optimal range in healthy individuals remains unclear.

Methods: This study analyzed data from 134,343 adults aged 40-79 in the MJ Health Check-up Cohort in Taiwan (2000-2017). Participants with prior cardiovascular disease or extreme/incomplete BMI data (≥50 kg/m2) were excluded. Covariates included lifestyle, blood pressure, and diet. All-cause mortality was assessed using Cox proportional hazards models.

Results: The mean age was 51.8 years, and 47.3 % were male. Most participants (62.7 %) had a BMI of 18.5-25. The average non-HDL-C level was 146.8 mg/dL. A U-shaped association was observed between non-HDL-C levels and all-cause mortality. Compared with the reference group (160-179 mg/dL), non-HDL-C levels of <100, 100-119, 120-139, and ≥200 mg/dL were linked to elevated mortality risk, with hazard ratios (HR) of 1.42 (95 % CI: 1.31-1.54), 1.19 (1.11-1.27), 1.11 (1.04-1.18), and 1.11 (1.03-1.20), respectively. The highest risk was noted in the 40-49 age group with non-HDL-C ≥200 mg/dL, particularly among females (HR 1.72, 95 % CI: 1.15-2.58). However, no significant increase in risk was observed for the same category in older age groups.

Conclusions: A non-HDL-C range of 160-179 mg/dL was associated with the lowest all-cause mortality among healthy Taiwanese adults. Both lower and higher levels were linked to increased mortality risk, highlighting the importance of maintaining moderate non-HDL-C levels to support longevity and overall health.

Keywords: Health behaviors; Mortality risk; Non-HDL-C.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The flowchart of participant inclusion.
Fig. 2
Fig. 2
The restricted cubic spline curve of non-high-density lipoprotein cholesterol and the all-cause mortality risk. The number of knots is set to six, with knot locations placed at six equally spaced values between the 5th and 95th percentiles of non-HDL-C. The reference value is 160 mg/dL. Adjusted variables include all 25 covariates in the Cox proportional hazards model, excluding non-HDL-C.
Fig. 3
Fig. 3
The survival curves at different levels of non-high-density lipoprotein cholesterol stratified by different age groups.
See this image and copyright information in PMC

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