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Association of Low-Density Lipoprotein With All-Cause and Cause-Specific Mortality Among Us Adults

17 Pages Posted: 27 Sep 2021

See all articles by Yihai Liu

Yihai Liu

Nanjing University - Department of Cardiology

Shengen Liao

Nanjing Medical University

Mingyue Wu

Nanjing University

Biao Xu

Nanjing University

Lina Kang

Nanjing University - Department of Cardiology

More...

Abstract

Background: To determine the association between levels of low-density lipoprotein-cholesterol (LDL-C) and all-cause and cause-specific mortality among US adults based on a prospective cohort study.

Methods: All participants were included from the National Health and Nutrition Examination Survey (NHANES) 1999-2014, a survey conducted by the Centers for Disease Control and Prevention (CDC). Among 10850 individuals, 1355 (12.5%) died after an average follow-up of 5.7 years. Baseline levels of LDL-C associated with risk of mortality were evaluated on a continuous scale (restricted cubic splines) and by a priori defined quantile categories with Cox regression models.

Results: The association between levels of LDL-C and the risk of all-cause mortality was L shaped, with low levels associated with an increased mortality risk. The concentration of LDL-C associated with the lowest risk of all-cause mortality was 124 mg/dL (3.2mmol/L) in the overall population, and 134 mg/dL (3.4mmol/L) in individuals not receiving lipid lowering treatment. Compared with individuals with concentrations of LDL-C of 110-134 mg/dL (the 3rd quartile), the multivariable adjusted hazard ratio for all-cause mortality was 1.18 (95% confidence interval 1.01 to 1.38) for individuals with LDL-C concentrations of less than 89 mg/dL (the lowest quartile). In participants with coronary heart diseases, the conclusion was similar but the critical point was lower.  

Conclusions: In the general population, low levels of LDL-C were associated with an increased risk of all-cause mortality, and the lowest risk of all-cause mortality for LDL-C concentration was 124mg/dL (3.2mmol/L). The critical point was 92 mg/dL (1.04 mmol/L) in participants with coronary heart disease.

Funding Information: None.

Declaration of Interests: The authors have nothing to disclose regarding conflict of interest with respect to this manuscript.

Ethics Approval Statement: The protocol was approved by the Institutional Review Board of the CDC and no new data was added.

Keywords: low density lipoprotein-cholesterol, all-cause mortality, cause-specific mortality

Suggested Citation

Liu, Yihai and Liao, Shengen and Wu, Mingyue and Xu, Biao and Kang, Lina, Association of Low-Density Lipoprotein With All-Cause and Cause-Specific Mortality Among Us Adults. Available at SSRN: https://ssrn.com/abstract=3931764 or http://dx.doi.org/10.2139/ssrn.3931764

Yihai Liu (Contact Author)

Nanjing University - Department of Cardiology

Shengen Liao

Nanjing Medical University ( email )

300 Guangzhou Road
Nanjing, Jiangsu 210029
China

Mingyue Wu

Nanjing University ( email )

Nanjing, Jiangsu 210093
China

Biao Xu

Nanjing University ( email )

Nanjing, Jiangsu 210093
China

Lina Kang

Nanjing University - Department of Cardiology ( email )

Nanjing
China