High-Density Lipoprotein Cholesterol and All-Cause and Cause-Specific Mortality Among the Elderly

• Published in: The journal of clinical endocrinology and metabolism Vol. 104; no. 8; pp. 3370 - 3378
• Main Authors: Li, Zhi-Hao, Lv, Yue-Bin, Zhong, Wen-Fang, Gao, Xiang, Byers Kraus, Virginia, Zou, Meng-Chen, Zhang, Xi-Ru, Li, Fu-Rong, Yuan, Jin-Qiu, Shi, Xiao-Ming, Wu, Xian-Bo, Mao, Chen
• Format: Journal Article
• Language: English
• Published: Washington, DC Endocrine Society 01.08.2019; Copyright Oxford University Press; Oxford University Press
• Subjects: Aged; Aged, 80 and over; Analysis; Cardiovascular diseases; Cardiovascular Diseases - mortality; Cause of Death; China; Cholesterol; Cholesterol, HDL - blood; Female; Geriatrics; Health aspects; Health risk assessment; High density lipoprotein; Humans; Male; Mortality; Nonlinear systems; Proportional Hazards Models; Prospective Studies; Risk Factors; China
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2018-02511

Abstract Context The patterns of the association between high-density lipoprotein cholesterol (HDL-C) concentrations and mortality among the elderly are still unclear. Objective To examine the association of HDL-C concentrations with mortality and to identify the optimal HDL-C concentration range that predicts the lowest risk of all-cause mortality among the elderly. Design This was a nationwide, community-based, prospective cohort study. Participants This study included 7766 elderly individuals (aged ≥65 years; mean age: 74.4 years) from the Health and Retirement Study. Cox proportional hazards models and Cox models with penalized smoothing splines were used to estimate hazard ratios (HRs) with 95% CI for all-cause and cause-specific mortality. Results During a median follow-up of 5.9 years, 1921 deaths occurred. After a full adjustment for covariates, a nonlinear (P < 0.001 for nonlinearity) association was found between HDL-C and all-cause mortality [minimum mortality risk at 71 mg/dL (1.84 mM)]; the risk for all-cause mortality was significantly higher in the groups with HDL-C concentration <61 mg/dL (1.58 mM; HR: 1.18; 95% CI: 1.05 to 1.33) and with HDL-C concentration >87 mg/dL (2.25 mM; HR: 1.56; 95% CI: 1.17 to 2.07) than in the group with HDL-C concentrations ranging from 61 to 87 mg/dL (1.58 to 2.25 mM). Nonlinear associations of HDL-C concentrations with both cardiovascular and noncardiovascular mortality were also observed (both P < 0.001 for nonlinearity). Conclusions Among the elderly, nonlinear associations were found between HDL-C and all-cause and cardiovascular mortality. The single optimal HDL-C concentration and range were 71 mg/dL and 61 to 87 mg/dL, respectively. In this community-based prospective cohort, U-shaped associations were found for high-density lipoprotein cholesterol with all-cause and cardiovascular mortality among the elderly.