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High-density lipoprotein cholesterol and all-cause mortality by sex and age: a prospective cohort study among 15.8 million adults

Authors
 Sang-Wook Yi  ;  Se-Jun Park  ;  Jee-Jeon Yi  ;  Heechoul Ohrr  ;  Hyeongsu Kim 
Citation
 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, Vol.50(3) : 902-913, 2021-06 
Journal Title
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
ISSN
 0300-5771 
Issue Date
2021-06
MeSH
Aged ; Cholesterol, HDL* ; Female ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; Young Adult
Keywords
Asians ; HDL-cholesterol ; Lipids ; epidemiology ; general population ; mortality
Abstract
Background: The associations between high-density lipoprotein cholesterol (HDL-C) levels and all-cause mortality are unclear in young adults (<45 years) and in Asian populations.

Methods: In total, 15 860 253 Korean adults underwent routine health examinations during 2009-10 and were followed until June 2018 for all-cause mortality. Hazard ratios (HRs) were calculated using Cox proportional hazard models.

Results: During a mean 8.4 years of follow-up, 555 802 individuals died. U-curve associations were found between HDL-C levels and mortality, irrespective of sex or age. The HDL-C ranges associated with the lowest mortality were 40-59 and 50-69 mg/dL (1.03-1.54 and 1.29-1.80 mmol/L) in men aged <65 and ≥65 years, respectively, and the corresponding ranges were 40-69 and 50-79 mg/dL (1.03-1.80 and 1.29-2.06 mmol/L) in women aged <45 and ≥45 years, respectively. For HDL-C ranges of 60-149 mg/dL (1.55-3.86 mmol/L), each 39 mg/dL (1 mmol/L) increase in HDL-C was associated with higher mortality [men: HR = 1.39; 95% confidence interval (CI) = 1.36-1.42; women: HR = 1.15, 95% CI = 1.11-1.18], adjusting for age. These positive associations were generally stronger at younger than older ages, whereas inverse associations for HDL-C ranges <60 mg/dL (1.55 mmol/L) were strongest in middle age (45-64 years). The U-curve associations were generally unchanged after adjustment for various confounders.

Conclusions: Korean adults showed U-curve associations of HDL-C with mortality, regardless of sex, and age. Younger adults had a lower optimal range and a stronger positive association with mortality than older adults in the high HDL-C range. Even moderately high HDL-C levels are not necessarily a sign of good health, especially in young adults.
DOI
10.1093/ije/dyaa243
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
Yonsei Authors
Ohrr, Hee Choul(오희철)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/190900
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