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High, low cholesterol associated with increased all-cause mortality
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Chinese adults with total cholesterol levels above 6.73 mmol/L or below 4.66 mmol/L have an elevated mortality risk, according to findings published in Nutrition, Metabolism & Cardiovascular Diseases.
“It has been well established that higher cholesterol levels are associated with greater atherosclerotic cardiovascular disease risk,” Kun Chen, PhD, a professor, doctoral supervisor and director in the department of epidemiology and biostatistics at Zhejiang University School of Public Health in Hangzhou, China, and colleagues wrote. “Recent evidence suggests that fluctuations of serum cholesterol in individuals may be independently associated with adverse outcomes.”
Chen and colleagues examined total cholesterol levels in 122,645 adults older than 40 years (mean age, 58.04 years; 56.35% women) using records from the Yinzhou Health Information System. The researchers also recorded instances of death from the Yinzhou Center for Disease Control and Prevention beginning from when participants were included in the study (2010-2014) to 2017, ultimately reporting that 4,563 participants died during the study. The most common cause of death was cancer (n = 1,514).
According to the researchers, there was a U-shaped association between total cholesterol levels and all-cause mortality, with the risk rising in both directions from a reference point of 5.46 mmol/L. In addition, they noted that the association had a comparable shape when looking at CVD mortality, stroke mortality and cancer mortality, with median reference points of 5.04 mmol/L, 4.96 mmol/L and 5.51 mmol/L, respectively.
On a more specific level, all-cause mortality risk was greater for those with a total cholesterol level of at least 6.73 mmol/L compared with those with a measure between 4.66 mmol/L and 5.18 mmol/L (HR = 1.32; 95% CI, 1.13-1.55), which was used as reference in the analysis. All-cause mortality risk was also elevated for those with total cholesterol of less than 3.63 mmol/L (HR = 1.41; 95% CI, 1.26-1.57), at least 3.63 mmol/L and less than 4.14 mmol/L (HR = 1.27; 95% CI, 1.16-1.4) and at least 4.14 mmol/L and less than 4.66 mmol/L (HR = 1.13; 95% CI, 1.03-1.23) vs. the reference group. The risk was numerically greater for those with total cholesterol of at least 5.18 mmol/L and less than 6.73 mmol/L, but not to a significant degree.
In terms of CV mortality, the odds were elevated for participants with total cholesterol of at least 6.73 mmol/L (HR = 1.64; 95% CI, 1.26-2.15), at least 5.7 mmol/L and less than 6.22 mmol/L (HR = 1.24; 95% CI, 1.01-1.53), at least 4.14 mmol/L and less than 4.66 mmol/L (HR = 1.19; 95% CI, 1-1.41), at least 3.63 mmol/L and less than 4.14 mmol/L (HR = 1.39; 95% CI, 1.16-1.67) and less than 3.63 mmol/L (HR = 1.31; 95% CI, 1.05-1.63).
According to the researchers, stroke mortality was more likely for participants with a total cholesterol level of at least 3.63 mmol/L and less than 4.14 mmol/L (HR = 1.13; 95% CI, 1.02-1.66), at least 5.7 mmol/L and less than 6.22 mmol/L (HR = 1.31; 95% CI, 1-1.72) and at least 6.73 mmol/L (HR = 1.94; 95% CI, 1.39-2.7).
The researchers measured total cholesterol inconsistency in four different ways and separated participants into quartiles based on these measurements. Participants in the fourth or highest quartiles had HRs between 1.21 and 1.25 for all-cause mortality and HRs between 1.41 and 1.5 for CVD mortality vs. those in the first quartile, according to the researchers, who noted that the other quartiles did not exhibit significant associations while no quartile had a significant connection in terms of cancer mortality.
“Current guidelines for the management of dyslipidemia only provide the reference for high level of cholesterol while our study found that low cholesterol can also increase the risk of mortality, which suggested the current [total cholesterol] target could be supplemented, especially in the elderly,” the researchers wrote. “We also demonstrated that high level of [total cholesterol] variability was associated with all-cause and CVD mortality. Our findings suggest that [total cholesterol] variability may be an important risk factor in the general population.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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