The U-Shaped Association of Non-High-Density Lipoprotein Cholesterol Levels With All-Cause and Cardiovascular Mortality Among Patients With Hypertension

• Published in: Frontiers in cardiovascular medicine Vol. 8; p. 707701
• Main Authors: Cheng, Qi, Liu, Xiao-cong, Chen, Chao-lei, Huang, Yu-qing, Feng, Ying-qing, Chen, Ji-yan
• Format: Journal Article
• Language: English
• Published: Frontiers Media S.A 14.07.2021
• Subjects: all-cause mortality; Cardiovascular Medicine; cardiovascular mortality; hypertension; NHANES; non-high-density lipoprotein cholesterol
• ISSN: 2297-055X; 2297-055X
• DOI: 10.3389/fcvm.2021.707701

Background: Non-high-density lipoprotein cholesterol (non-HDL-C) is a valuable indicator in routine blood lipid tests, but the associations of non-HDL-C with mortality in hypertensive population still remain uncertain. Methods: In the National Health and Nutrition Examination Surveys from 1999 to 2014, participants having hypertension were included and grouped by non-HDL-C levels (<130, 130–159, 160–189, 190–219, and ≥220 mg/dl). Multivariate Cox regression was conducted for calculation of hazard ratios (HR) and 95% confidence interval (CI). To reveal the relationship between non-HDL-C and mortality, Kaplan–Meier survival curves, restricted cubic spline, linear regression, and subgroup analysis were also applied. Results: A total of 12,169 participants (47.52% males, mean age 57.27 ± 15.79 years) were included. During average follow-up of 92.5 months, 1,946 (15.99%) all-cause deaths and 422 (3.47%) cardiovascular deaths occurred. After adjusting for confounders, the association of non-HDL-C with mortality was detected as U-shaped. Threshold values were observed at 158 mg/dl for all-cause mortality and 190 mg/dl as to cardiovascular mortality. Below the threshold, every 10 mg/dl increment in non-HDL-C attributed to relatively low all-cause mortality significantly (HR = 0.94, 95% CI: 0.92–0.96). Above the threshold, non-HDL-C has significant positive associations with both all-cause (HR = 1.03, 95% CI: 1.01–1.05) and cardiovascular mortality (HR = 1.09, 95% CI: 1.05–1.14). For subgroups analysis, similar results were found among participants age <65 years old, non-white population, those were not taking lipid-lowering drugs, and subjects with body mass index (BMI) ≥25 kg/m 2 . Conclusion: The U-shaped association was detected between non-HDL-C and mortality among hypertensive population.