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

Zhi Hao Li, Yue Bin Lv, Wen Fang Zhong, Xiang Gao, Virginia Byers Kraus, Meng Chen Zou, Xi Ru Zhang, Fu Rong Li, Jin Qiu Yuan, Xiao Ming Shi, Xian Bo Wu, Chen Mao

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)3370-3378
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume104
Issue number8
DOIs
StatePublished - Jun 19 2019

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HDL Cholesterol
Mortality
Hazards
Proportional Hazards Models
Retirement
Splines
Cohort Studies
Health
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

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. / High-Density Lipoprotein Cholesterol and All-Cause and Cause-Specific Mortality among the Elderly. In: Journal of Clinical Endocrinology and Metabolism. 2019 ; Vol. 104, No. 8. pp. 3370-3378.
@article{8e2c1b3c3c884c9c8e398f3ffc35d83f,
title = "High-Density Lipoprotein Cholesterol and All-Cause and Cause-Specific Mortality among the Elderly",
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.",
author = "Li, {Zhi Hao} and Lv, {Yue Bin} and Zhong, {Wen Fang} and Xiang Gao and {Byers Kraus}, Virginia and Zou, {Meng Chen} and Zhang, {Xi Ru} and Li, {Fu Rong} and Yuan, {Jin Qiu} and Shi, {Xiao Ming} and Wu, {Xian Bo} and Chen Mao",
year = "2019",
month = "6",
day = "19",
doi = "10.1210/jc.2018-02511",
language = "English (US)",
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pages = "3370--3378",
journal = "Journal of Clinical Endocrinology and Metabolism",
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Li, ZH, Lv, YB, Zhong, WF, Gao, X, Byers Kraus, V, Zou, MC, Zhang, XR, Li, FR, Yuan, JQ, Shi, XM, Wu, XB & Mao, C 2019, 'High-Density Lipoprotein Cholesterol and All-Cause and Cause-Specific Mortality among the Elderly', Journal of Clinical Endocrinology and Metabolism, vol. 104, no. 8, pp. 3370-3378. https://doi.org/10.1210/jc.2018-02511

High-Density Lipoprotein Cholesterol and All-Cause and Cause-Specific Mortality among the Elderly. / 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.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 104, No. 8, 19.06.2019, p. 3370-3378.

Research output: Contribution to journalArticle

TY - JOUR

T1 - High-Density Lipoprotein Cholesterol and All-Cause and Cause-Specific Mortality among the Elderly

AU - Li, Zhi Hao

AU - Lv, Yue Bin

AU - Zhong, Wen Fang

AU - Gao, Xiang

AU - Byers Kraus, Virginia

AU - Zou, Meng Chen

AU - Zhang, Xi Ru

AU - Li, Fu Rong

AU - Yuan, Jin Qiu

AU - Shi, Xiao Ming

AU - Wu, Xian Bo

AU - Mao, Chen

PY - 2019/6/19

Y1 - 2019/6/19

N2 - 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.

AB - 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.

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U2 - 10.1210/jc.2018-02511

DO - 10.1210/jc.2018-02511

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VL - 104

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JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

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