Association Between Renal Dysfunction and Low HDL Cholesterol Among the Elderly in China

Aijun You; Yaxin Li; Brian Tomlinson; Longfei Yue; Kaijie Zhao; Huimin Fan; Zhongmin Liu; Yuzhen Zhang; Liang Zheng

doi:10.3389/fcvm.2021.644208

Association Between Renal Dysfunction and Low HDL Cholesterol Among the Elderly in China

Front Cardiovasc Med. 2021 May 12:8:644208. doi: 10.3389/fcvm.2021.644208. eCollection 2021.

Authors

Aijun You^{1

2

3}, Yaxin Li^{1

2

3}, Brian Tomlinson^{1

2

4}, Longfei Yue⁵, Kaijie Zhao⁶, Huimin Fan^{1

2}, Zhongmin Liu^{1

2}, Yuzhen Zhang^{1

2}, Liang Zheng^{1

2}

Affiliations

¹ Shanghai Heart Failure Research Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
² Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
³ Department of Epidemiology and Public Health, Tongji University School of Medicine, Shanghai, China.
⁴ Faculty of Medicine, Macau University of Science and Technology, Macau, China.
⁵ Anshun People's Hospital, Guizhou, China.
⁶ Community Health Service Center, Shanghai, China.

Abstract

Objective: Chronic kidney disease (CKD) and cardiovascular disease (CVD) have a high morbidity and mortality among the elderly. Low levels of high-density lipoprotein cholesterol (HDL-C), a traditional risk marker for CVD, are common in CKD patients. Little is known about the association of low HDL-C with renal dysfunction in the community dwelling population. Methods: This was a population-based cross-sectional study included 4,753 participants enrolled in a prospective study, the Shanghai Elderly Cardiovascular Health (SHECH) study. Estimated glomerular filtration rate (eGFR), calculated by the Chinese Modification of Diet in Renal Disease (C-MDRD equation), was used to assess renal dysfunction. Associations between renal dysfunction and low HDL-C were evaluated using multiple logistic regression models and restricted cubic splines. Results: Of 4,649 individuals who met inclusion criteria, 620 (13.34%) had low HDL-C at <40 mg/dl. In the fully adjusted model, lower eGFR of <60 ml/min/1.73 m² (OR, 2.03; 95% CI, 1.21-3.43) and marginal eGFR of 60 to 90 ml/min/1.73 m² (OR, 1.26; 95% CI, 1.01-1.58) were significantly associated with low HDL-C, compared with normal eGFR of ≥90 ml/min/1.73 m². Moreover, consistent findings were obtained in subsidiary analyses using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Fully adjusted cubic spline models indicated a significant dose-response relationship between eGFR and low HDL-C (P for non-linearity, 0.356). Conclusion: In this general elderly population, renal dysfunction was independently and significantly associated with low HDL-C, and the prevalence of low HDL-C increased with decreasing eGFR, such that even slight changes in renal function may be associated with altered lipid levels.

Keywords: cardiovascular prevention; dyslipidemia; estimated glomerular filtration rate; high-density lipoprotein cholesterol; renal dysfunction.