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The U Shaped Relationship Between High-Density Lipoprotein Cholesterol and All-Cause or Cause-Specific Mortality in Adult Population

Authors Huang Y, Liu X, Lo K, Liu L, Yu Y, Chen C, Huang J, Feng Y, Zhang B

Received 15 July 2020

Accepted for publication 27 August 2020

Published 2 October 2020 Volume 2020:15 Pages 1883—1896


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Zhi-Ying Wu

Yu-qing Huang,1 Xiao-cong Liu,1 Kenneth Lo,1,2 Lin Liu,1 Yu-ling Yu,1 Chao-lei Chen,1 Jia-yi Huang,1 Ying-qing Feng,1 Bin Zhang1

1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People’s Republic of China; 2Department of Epidemiology, Centre for Global Cardio-Metabolic Health, Brown University, Providence, RI, USA

Correspondence: Ying-qing Feng; Bin Zhang
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou 510080, People’s Republic of China
Tel/ Fax +86-20-83827812

Purpose: The associations of high-density lipoprotein cholesterol (HDL-C) with mortality are still unclear. We explored the associations of HDL-C with all-cause and cause-specific mortality in an adult population.
Methods: Deaths were classified into all-cause, cardiovascular, and cancer mortality. Survival curve, multivariate Cox regression, and subgroup analyses were conducted, and hazard ratio (HR) and 95% confidence interval (CI) were performed. We fitted Cox regression models for all-cause, cardiovascular, and cancer mortality to evaluate their associations with categories of HDL-C (≤ 30, 31– 40, 41– 50, 51– 60 [reference], 61– 70, > 70 mg/dL).
Results: A total of 42,145 (20,415 (48.44%) males, mean age 47.12± 19.40 years) subjects were enrolled. At an average follow-up of 97.52± 54.03 months, all-cause, cardiovascular, and cancer mortality numbers were 5,061 (12.01), 1,081 (2.56%), and 1,061 (2.52%), respectively. When compared with the reference group (HDL-C: 51– 60 mg/dL), a U-shaped association was apparent for all-cause mortality, with elevated risk in participants with the lowest (≤ 30 mg/dL) (HR=1.33; 95% CI=1.14– 1.56) and highest (> 70 mg/dL) (HR=1.14; 95% CI=1.02– 1.27) HDL-C concentration. Associations for cardiovascular and cancer mortality were non-linear. An elevated risk for cancer mortality was observed in those with the highest HDL-C concentration (HR=1.06; 95% CI– 0.84– 1.34) compared with the reference group, although it was not statistically significant. The effect of HDL-C on mortality was adjusted by some traditional risk factors including age, gender, race, or comorbidities.
Conclusion: A U-shaped association was observed between HDL-C and all-cause mortality among an adult population.

Keywords: high-density lipoprotein cholesterol, mortality, all-cause mortality, cause-specific mortality

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