Abstract
BackgroundThe relationship between serum cholesterol and mortality remains disputed. This study aimed to examine the association of low and high-density lipoprotein cholesterol (LDL-C and HDL-C) with all-cause mortality among community-dwelling older adults in the Shanghai Aging Study.MethodsWe followed 3,239 participants free of lipid-lowering agents for a median of 10 years. Levels of LDL-C and HDL-C were measured at baseline using fasting blood samples. Survival status was confirmed by the local mortality surveillance system. The associations between the levels of LDL-C, HDL-C, and all-cause mortality were assessed by Cox proportional hazards models.ResultsThe increment of LDL-C concentration was related to a lower risk of mortality (p for trend < 0.05). Using the highest quintile of LDL-C (≥4.10 mmol/L) as a reference, the lowest quintile of LDL-C (<2.61 mmol/L) was associated with the highest risk of mortality, after adjusting for confounders (HR 1.67; 95% CI 1.26–2.21), exclusion of death within the first 2 years of follow-up (HR 1.57; 95% CI 1.17–2.11), and exclusion of functionally impaired participants (HR 1.46; 95% CI 1.07–2.00). A U-shape relationship was found between HDL-C level and the mortality risk. Using the third quintile of HDL-C (1.21–1.39 mmol/L) as a reference, HR (95% CI) was 1.46 (1.09–1.95) for the lowest quintile (<1.09 mmol/L) and 1.45 (1.07–1.96) for the highest quintile (≥1.61 mmol/L) of HDL-C, after adjusting for confounders; and 1.57 (1.15–2.15) for the lowest quintile and 1.45 (1.04–2.01) for the highest quintile of HDL-C, after exclusion of death within the first 2 years of follow-up; and 1.55 (1.11–2.16) for the lowest quintile and 1.42 (1.00–2.02) for the highest quintile of HDL-C, after exclusion of functionally impaired participants.ConclusionsWe found an inverse association of LDL-C and a U-shape relationship of HDL-C with long-term all-cause mortality in a cohort with community-dwelling older Chinese adults. Levels of LDL-C and HDL-C are suggested to be managed properly in late life.
Highlights
The health status of older individuals is complicated, owing to multiple subclinical and clinical diseases
Serum cholesterol is transported in the blood attached to lipoproteins, such as low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C)
The relation between late-life LDL-C, HDL-C, and all-cause mortality has been reported by population-based cohort studies
Summary
The health status of older individuals is complicated, owing to multiple subclinical and clinical diseases. The relation between late-life LDL-C, HDL-C, and all-cause mortality has been reported by population-based cohort studies. Some studies reported either a lack of an association or an inverse association for LDL-C and mortality [1–11]. Some studies concluded a Ushape association for HDL-C, with both lower and higher HDL-C concentrations associated with an elevated risk of mortality [3, 12]. The Shanghai Aging Study recruited a large cohort of community-dwelling older adults during 2010– 2012 and prospectively monitored the survival status of the participants until the end of 2020. We aimed to examine the association between LDL-C, HDL-C level, and all-cause mortality in older Chinese adults. This study aimed to examine the association of low and high-density lipoprotein cholesterol (LDL-C and HDL-C) with all-cause mortality among community-dwelling older adults in the Shanghai Aging Study
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