Sex-Specific Relationships between HDL-Cholesterol Levels and 10-Year Mortality in Individuals with Atherosclerotic Cardiovascular Disease: A Nationwide Cohort Study of South Koreans
Large epidemiological studies show U-shaped relationships between high-density lipoprotein cholesterol (HDL-C) levels and all-cause mortality in individuals without atherosclerotic cardiovascular diseases (ASCVD). Association in those with ASCVD by sex is unclear. We examined the association between...
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MDPI AG
2023-11-01
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| Series: | Metabolites |
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| Online Access: | https://www.mdpi.com/2218-1989/13/12/1175 |
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| author | Hyun Suk Yang Ho Jin Jeong Hyeongsu Kim Seungho Lee Mina Hur |
| author_facet | Hyun Suk Yang Ho Jin Jeong Hyeongsu Kim Seungho Lee Mina Hur |
| author_sort | Hyun Suk Yang |
| collection | DOAJ |
| description | Large epidemiological studies show U-shaped relationships between high-density lipoprotein cholesterol (HDL-C) levels and all-cause mortality in individuals without atherosclerotic cardiovascular diseases (ASCVD). Association in those with ASCVD by sex is unclear. We examined the association between HDL-C levels and 10-year all-cause mortality in subjects (≥40 years of age) with ASCVD using the 2010 National Health Insurance Service and the National Death Registry of Korea. We categorized HDL-C levels into three groups (low: <40 mg/dL for males, <50 mg/dL for females; high: 40–90 mg/dL for males, 50–90 mg/dL for females; extremely high: >90 mg/dL) and 10 mg/dL intervals. We conducted a sex-stratified and adjusted Cox proportional hazards analysis. Out of 1,711,548 individuals (54% female, mean age 61.4 years), 10-year mortality was observed in 218,252 (12.8%). Males had a higher mortality rate than females (16.2% vs. 9.8%; <i>p</i> < 0.001). When adjusting for age, body mass index, LDL-cholesterol, triglycerides, hypertension, diabetes, smoking, and alcohol consumption, the low and extremely high HDL-C groups had significantly higher hazard ratios for 10-year mortality compared to the high HDL-C group in males [1.183 (1.166–1.199), 1.359 (1.288–1.434)] and in females [1.153 (1.138–1.169), 1.095 (1.029–1.167)]. The frequency distribution bars for the 10-year mortality rate showed sex-specific nadirs of 50–59 mg/dL in males and 70–79 mg/dL in females. In this ASCVD cohort, the extremely high HDL-C (>90 mg/dL) group had 35.9% and 9.5% higher 10-year mortality risks than the high HDL-C group for males and females, respectively. There was a slightly U-shaped relationship between baseline HDL-C levels and a 10-year mortality rate, with earlier inflection in males than in females. |
| first_indexed | 2024-03-08T20:33:10Z |
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| issn | 2218-1989 |
| language | English |
| last_indexed | 2024-03-08T20:33:10Z |
| publishDate | 2023-11-01 |
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| series | Metabolites |
| spelling | doaj.art-d58363c80c6e4d9aaeea6421a1f368ed2023-12-22T14:24:25ZengMDPI AGMetabolites2218-19892023-11-011312117510.3390/metabo13121175Sex-Specific Relationships between HDL-Cholesterol Levels and 10-Year Mortality in Individuals with Atherosclerotic Cardiovascular Disease: A Nationwide Cohort Study of South KoreansHyun Suk Yang0Ho Jin Jeong1Hyeongsu Kim2Seungho Lee3Mina Hur4Departments of Cardiovascular Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Republic of KoreaDepartment of Preventive Medicine, Konkuk University School of Medicine, Seoul 05029, Republic of KoreaDepartment of Preventive Medicine, Konkuk University School of Medicine, Seoul 05029, Republic of KoreaDepartments of Preventive Medicine, Dong-A University School of Medicine, Busan 49315, Republic of KoreaDepartment of Laboratory Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Republic of KoreaLarge epidemiological studies show U-shaped relationships between high-density lipoprotein cholesterol (HDL-C) levels and all-cause mortality in individuals without atherosclerotic cardiovascular diseases (ASCVD). Association in those with ASCVD by sex is unclear. We examined the association between HDL-C levels and 10-year all-cause mortality in subjects (≥40 years of age) with ASCVD using the 2010 National Health Insurance Service and the National Death Registry of Korea. We categorized HDL-C levels into three groups (low: <40 mg/dL for males, <50 mg/dL for females; high: 40–90 mg/dL for males, 50–90 mg/dL for females; extremely high: >90 mg/dL) and 10 mg/dL intervals. We conducted a sex-stratified and adjusted Cox proportional hazards analysis. Out of 1,711,548 individuals (54% female, mean age 61.4 years), 10-year mortality was observed in 218,252 (12.8%). Males had a higher mortality rate than females (16.2% vs. 9.8%; <i>p</i> < 0.001). When adjusting for age, body mass index, LDL-cholesterol, triglycerides, hypertension, diabetes, smoking, and alcohol consumption, the low and extremely high HDL-C groups had significantly higher hazard ratios for 10-year mortality compared to the high HDL-C group in males [1.183 (1.166–1.199), 1.359 (1.288–1.434)] and in females [1.153 (1.138–1.169), 1.095 (1.029–1.167)]. The frequency distribution bars for the 10-year mortality rate showed sex-specific nadirs of 50–59 mg/dL in males and 70–79 mg/dL in females. In this ASCVD cohort, the extremely high HDL-C (>90 mg/dL) group had 35.9% and 9.5% higher 10-year mortality risks than the high HDL-C group for males and females, respectively. There was a slightly U-shaped relationship between baseline HDL-C levels and a 10-year mortality rate, with earlier inflection in males than in females.https://www.mdpi.com/2218-1989/13/12/1175high-density lipoprotein cholesterolatherosclerotic cardiovascular diseasesall-cause mortalitybiomarker |
| spellingShingle | Hyun Suk Yang Ho Jin Jeong Hyeongsu Kim Seungho Lee Mina Hur Sex-Specific Relationships between HDL-Cholesterol Levels and 10-Year Mortality in Individuals with Atherosclerotic Cardiovascular Disease: A Nationwide Cohort Study of South Koreans Metabolites high-density lipoprotein cholesterol atherosclerotic cardiovascular diseases all-cause mortality biomarker |
| title | Sex-Specific Relationships between HDL-Cholesterol Levels and 10-Year Mortality in Individuals with Atherosclerotic Cardiovascular Disease: A Nationwide Cohort Study of South Koreans |
| title_full | Sex-Specific Relationships between HDL-Cholesterol Levels and 10-Year Mortality in Individuals with Atherosclerotic Cardiovascular Disease: A Nationwide Cohort Study of South Koreans |
| title_fullStr | Sex-Specific Relationships between HDL-Cholesterol Levels and 10-Year Mortality in Individuals with Atherosclerotic Cardiovascular Disease: A Nationwide Cohort Study of South Koreans |
| title_full_unstemmed | Sex-Specific Relationships between HDL-Cholesterol Levels and 10-Year Mortality in Individuals with Atherosclerotic Cardiovascular Disease: A Nationwide Cohort Study of South Koreans |
| title_short | Sex-Specific Relationships between HDL-Cholesterol Levels and 10-Year Mortality in Individuals with Atherosclerotic Cardiovascular Disease: A Nationwide Cohort Study of South Koreans |
| title_sort | sex specific relationships between hdl cholesterol levels and 10 year mortality in individuals with atherosclerotic cardiovascular disease a nationwide cohort study of south koreans |
| topic | high-density lipoprotein cholesterol atherosclerotic cardiovascular diseases all-cause mortality biomarker |
| url | https://www.mdpi.com/2218-1989/13/12/1175 |
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