Cholesterol paradox in the community-living old adults: is higher better?

Sheng-Shu Wang; Shan-Shan Yang; Chun-Jiang Pan; Jian-Hua Wang; Hao-Wei Li; Shi-Min Chen; Jun-Kai Hao; Xue-Hang Li; Rong-Rong Li; Bo-Yan Li; Jun-Han Yang; Yue-Ting Shi; Huai-Hao Li; Ying-Hui Bao; Wen-Chang Wang; Sheng-Yan DU; Yao He; Chun-Lin Li; Miao Liu

doi:10.26599/1671-5411.2023.12.003

Cholesterol paradox in the community-living old adults: is higher better?

J Geriatr Cardiol. 2023 Dec 28;20(12):837-844. doi: 10.26599/1671-5411.2023.12.003.

Authors

Sheng-Shu Wang¹, Shan-Shan Yang², Chun-Jiang Pan³, Jian-Hua Wang¹, Hao-Wei Li¹, Shi-Min Chen¹, Jun-Kai Hao⁴, Xue-Hang Li¹, Rong-Rong Li¹, Bo-Yan Li¹, Jun-Han Yang¹, Yue-Ting Shi¹, Huai-Hao Li¹, Ying-Hui Bao¹, Wen-Chang Wang¹, Sheng-Yan DU¹, Yao He^{1

5}, Chun-Lin Li⁶, Miao Liu⁷

Affiliations

¹ Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, the Second Medical Center, Chinese PLA General Hospital, Beijing, China.
² Department of Disease Prevention and Control, the First Medical Center, Chinese PLA General Hospital, Beijing, China.
³ Department of Disease Control and Prevention, Chinese PLA Strategic Support Force Characteristic Medical Center, Beijing, China.
⁴ Department of Health Service, the Second Medical Center, Chinese PLA General Hospital, Beijing, China.
⁵ Department of Epidemiology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, China.
⁶ Institute of Endocrinology, the Second Medical Center, Chinese PLA General Hospital, Beijing, China.
⁷ Department of anti-NBC Medicine, Chinese PLA Medical School, Chinese PLA General Hospital, Beijing, China.

Abstract

Objective: To evaluate the associations of lipid indicators and mortality in Beijing Elderly Comprehensive Health Cohort Study.

Methods: A prospective cohort was conducted based on Beijing Elderly Comprehensive Health Cohort Study with 4499 community older adults. After the baseline survey, the last follow-up was March 31, 2021 with an average 8.13 years of follow-up. Cox proportional hazard model was used to estimate the hazard ratios (HR) with 95% CI for cardiovascular disease (CVD) death and all-cause death in associations with baseline lipid indicators.

Results: A total of 4499 participants were recruited, and the mean levels of uric acid, body mass index, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, total cholesterol (TC), triglyceride, and low-density lipoprotein cholesterol (LDL-C) showed an upward trend with the increasing remnant cholesterol (RC) quarters (P_trend < 0.05), while the downward trend was found in high-density lipoprotein cholesterol (HDL-C). During the total 36,596 person-years follow-up, the CVD mortality and all-cause mortality during an average 8.13 years of follow-up was 3.87% (95% CI: 3.30%-4.43%) and 14.83% (95% CI: 13.79%-15.86%) with 174 CVD death participants and 667 all-cause death participants. After adjusting for confounders, the higher level of TC (HR = 0.854, 95% CI: 0.730-0.997), LDL-C (HR = 0.817, 95% CI: 0.680-0.982) and HDL-C (HR = 0.443, 95% CI: 0.271-0.724) were associated with lower risk of CVD death, and the higher level of HDL-C (HR = 0.637, 95% CI: 0.501-0.810) were associated with lower risk of all-cause death. The higher level of RC (HR = 1.276, 95% CI: 1.010-1.613) increase the risk of CVD death. Compared with the normal lipid group, TC ≥ 6.20 mmol/L group and LDL-C ≥ 4.10 mmol/L group were no longer associated with lower risk of CVD death, while RC ≥ 0.80 mmol/L group was still associated with higher risk of CVD death. In normal lipid group, the higher levels of TC, LDL-C and HDL-C were related with lower CVD death.

Conclusions: In community older adults, higher levels of TC and HDL-C were associated with lower CVD mortality in normal lipid reference range. Higher RC was associated with higher CVD mortality, which may be a better lipid indicator for estimating the CVD death risk in older adults.