| ObjectiveThis study aimed to investigate the association between high-density lipoprotein cholesterol(HDL-C)levels and the risk of all-cause mortality and cardiovascular disease mortality in Chinese adults with different characteristics,and to provide a scientific basis for formulating chronic diseases prevention and control strategies and improving the life expectancy of Chinese residents.MethodsA total of 109,681 respondents with complete ID information were included in this study based on the China Chronic Disease and Risk Factors Surveillance in 2013.Data on deaths were derived from the national cause of death surveillance data from 2013 to 2019,and according to the tenth edition of the International Classification of Diseases(ICD-10)to classify the causes of death.By using the method of database matching,the China Chronic Disease and Risk Factors Surveillance database was linked to the national cause of death monitoring database,and then the death information of the subjects was obtained,so as to establish the natural population cohort to track the death from chronic disease risk factors and form the dynamic information chain.Continuous variables that were normally distributed or approximately normally distributed were represented by mean and standard deviation,and differences between groups were compared by t-test or one-way analysis of variance.Classified variables were represented by frequency(percentage),and differences between groups were compared by χ2 test.HDL-C levels were divided into seven groups.The hazard ratios and 95%confidence intervals between HDL-C levels and all-cause mortality were analyzed by Cox proportional hazards models,and the hazard ratios and 95%confidence intervals between HDL-C levels and cardiovascular mortality were analyzed by competing risk models.Subgroup analysis and sensitivity analysis were performed,respectively.Linear or non-linear associations between HDL-C levels and the risk of all-cause and cardiovascular mortality were analysed using restricted cubic spline models.This study was two-sided test,the test level α=0.05.ResultsAccording to the inclusion and exclusion criteria,a total of 109,681 respondents were included in this study,among whom 43.2%were males and 56.8%were females.The proportion of patients aged less than 40,40～,50～,60～and≥70 years old were 20.1%,25.5%,25.6%,19.6%and 9.2%,respectively.The baseline serum HDL-C level of subjects was 52.95 ±15.28mg/dL on the whole,and 51.03±15.70mg/dL for men and 54.40±14.78mg/dL for women,which was significantly higher in women than in men(P<0.05),In this study;the prevalence of low HDL cholesterol was 19.6%,24.9%in males and 15.6%in females,and the prevalence of low HDL cholesterol in females was significantly lower than that in males(P<0.05).This study was followed up from 2013 to 2019,with an average follow-up of 5.93 years.A total of 4 254 deaths were followed up,with an average mortality density of 653.90/100,000 person-years-HDL-C levels of 40-49.9mg/dL were used as the control group,and the risk of all-cause death with an HDL-C level<30mg/dL was 1.48 times(HR:1.48,95%CI:1.26-1.73)higher than the control group after full adjustment for confounding factors,and no statistically significant association was found between HDL-C levels≥80mg/dL and the risk of all-cause death(HR:1.03,95%CI:0.89-1.18).However,in the dose-response model of HDL-C level and the risk of all-cause death,it was found that there was a U-shaped association between HDL-C level and the risk of all-cause death.Both Low and high levels of HDL-C increased the risk of all-cause death,but the intensity of the association between high levels of HDL-C and the risk of all-cause death was significantly lower than that of low levels of HDL-C.A total of 1 791 cardiovascular deaths occurred in this study,including 668 ischemic heart disease cases and 937 cerebrovascular disease cases.HDL-C levels of 40-49.9mg/dL were used as the control group.After adjusting for confounding factors,the risk of death from cardiovascular disease in the group with HDL-C<30mg/dL was 1.50 times significant higher than that in the control group.No statistical difference was found in the association between HDL-C and the risk of cardiovascular death in other groups.The dose-response relationship model showed an L-shaped association between HDL-C and the risk of cardiovascular death and low levels of HDL-C had a higher risk of cardiovascular death.No statistical association was found between high levels of HDL-C and the risk of cardiovascular death.Further analysis found that the association between low levels of HDL-C and ischemic heart disease death was not statistically significant,and high levels of HDL-C were associated with a lower risk of ischemic heart disease death.The association between HDL-C and the risk of cerebrovascular disease death showed an L-shaped correlation.Low levels of HDL-C had a higher risk of cerebrovascular disease death,and there was no statistical difference between high levels of HDL-C and the risk of cerebrovascular disease death.Subgroup analysis was conducted by gender,age(<60 years old,≥60 years old),smoking(never smoking,current smoking and former smoking),alcohol consumption(never drinking,light drinking and heavy drinking),BMI(<24 kg/m2,≥24 kg/m2).Cox proportional hazards models or competing risk models showed no statistically significant association between HDL-C and the risk of all-cause and cardiovascular death among current smokers and light drinkers.In other subpopulations,low levels of HDL-C were associated with an increased risk of all-cause and cardiovascular death,and high levels of HDL-C were not associated with a statistically significant risk of death.There was no obvious change in sensitivity analysis.ConclusionThere was a U-shaped association between HDL-C and the risk of all-cause death.Both low and high levels of HDL-C increased the risk of all-cause death,but the intensity of the association between high levels of HDL-C and the risk of all-cause death was significantly lower than that of low levels of HDL-C.There was an L-shaped association between HDL-C and the risk of death from cardiovascular disease and cerebrovascular disease.Low levels of HDL-C were associated with a higher risk of death,and there was no statistical difference between high levels of HDL-C and the risk of death.The results of this study do not support the assumption that higher levels of HDL-C are better,as high levels of HDL-C may increase the risk of all-cause mortality.Clinicians should be aware that when using HDL-C for risk assessment,they need to focus not only on people with too low HDL-C but also on people with too high HDL-C. |
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