Low and High-Density Lipoprotein Cholesterol and 10-Year Mortality in Community-Dwelling Older Adults: The Shanghai Aging Study

Wanqing Wu; Zhenxu Xiao; Xiaoniu Liang; Qianhua Zhao; Jianfeng Luo; Ding Ding

doi:10.3389/fmed.2022.783618

Low and High-Density Lipoprotein Cholesterol and 10-Year Mortality in Community-Dwelling Older Adults: The Shanghai Aging Study

Front Med (Lausanne). 2022 Mar 8:9:783618. doi: 10.3389/fmed.2022.783618. eCollection 2022.

Authors

Wanqing Wu^{1

2}, Zhenxu Xiao^{1

2}, Xiaoniu Liang^{1

2}, Qianhua Zhao^{1

2}, Jianfeng Luo^{3

4}, Ding Ding^{1

2}

Affiliations

¹ Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
² National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
³ Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.
⁴ The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China.

Abstract

Background: The 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.

Methods: We 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.

Results: The 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.

Conclusions: We 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.

Keywords: HDL-C; LDL-C; cohort study; mortality; older adults.