Serum lipids and mortality in an American Indian population: A longitudinal study

J Diabetes Complications. 2018 Jan;32(1):18-26. doi: 10.1016/j.jdiacomp.2017.09.015. Epub 2017 Oct 3.


Background: In Caucasians, lower triglycerides (TG), total or LDL cholesterol and high HDL cholesterol are generally associated with lower mortality. However, low cholesterol is associated with higher mortality in some Asian populations. This study examines the relationship between serum lipids and mortality in American Indians.

Methods: 2125 American Indians aged ≥40years were examined biennially between 1993 and 2007. Vital status was determined through 2011. Mortality rates, adjusted for age, sex and diabetes, were calculated using Poisson regression.

Results: The median baseline age was 46years and 61% were women. Over a median follow-up of 10.1years, 522 deaths occurred. Relationships between baseline lipids, except for HDL cholesterol, and all-cause mortality were negative and linear in persons without diabetes and U-shaped in persons with diabetes. For HDL cholesterol, the relationship was U-shaped in the total cohort. Cardiovascular mortality was positively associated with total, LDL and non-HDL cholesterol whereas lower lipid concentrations were adversely associated with mortality from liver disease or external causes, except for HDL cholesterol, where associations were positive.

Conclusion: The common belief that low cholesterol and TG are beneficial for health is not universally observed; evidence suggests increased mortality at both ends of the cholesterol and TG distributions.

Keywords: Cholesterol; Diabetes; Lipid; Mortality; Triglycerides.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Adult
  • Aged
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / ethnology
  • Cardiovascular Diseases / mortality
  • Cause of Death
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Cohort Studies
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / ethnology
  • Diabetes Mellitus / mortality
  • Female
  • Humans
  • Indians, North American / statistics & numerical data*
  • Lipids / blood*
  • Lipoproteins / blood
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Mortality / ethnology*
  • Triglycerides / blood


  • Cholesterol, HDL
  • Cholesterol, LDL
  • Lipids
  • Lipoproteins
  • Triglycerides