解放军医学杂志2025，Vol.50Issue(9)：1089-1096,8.DOI:10.11855/j.issn.0577-7402.0899.2025.0730
高密度脂蛋白胆固醇与老年人群全因死亡和原因特异性死亡的关联:一项前瞻性队列研究
Association of high-density lipoprotein cholesterol with all-cause and cause-specific mortality among the elderly population:a prospective cohort study
摘要
Abstract
Objective To investigate the association between high-density lipoprotein cholesterol(HDL-C)levels and all-cause and cause-specific mortality in the elderly population,and to determine the optimal HDL-C concentration range associated with the lowest mortality risk.Methods This prospective cohort study included 16,632 elderly individuals aged≥60 years from the National Health and Nutrition Examination Survey(NHANES)between 1999 and 2018.Participants were divided into 5 groups based on HDL-C levels:<40 mg/dl group(n=2933),40-49 mg/dl group(n=4602),50-59 mg/dl group(n=3824),60-79 mg/dl group(n=3988),and≥80 mg/dl group(n=1285).Mortality data were obtained by linking records with the National Death Index(NDI).Cox proportional hazards regression and restricted cubic spline curves were used to analyze the association between HDL-C and mortality risk.Subgroup and sensitivity analyses were conducted.Results Multivariable-adjusted Cox models showed that,compared with 50-59 mg/dl HDL-C group,HDL-C<40 mg/dl group had significantly higher risks of all-cause mortality(HR=1.17,95%CI 1.05-1.31,P=0.006),cardiovascular mortality(HR=1.32,95%CI 1.08-1.58,P=0.001),and non-cardiovascular mortality(HR=1.14,95%CI 1.02-1.27,P=0.013).HDL-C≥80 mg/dl group had significantly higher risks of all-cause mortality(HR=1.18,95%CI 1.03-1.35,P=0.027)and non-cardiovascular mortality(HR=1.23,95%CI 1.03-1.46,P=0.029),but no significant effect on cardiovascular mortality(HR=1.07,95%CI 0.88-1.28,P=0.492).Restricted cubic spline curves revealed U-shaped associations between HDL-C and all-cause/non-cardiovascular mortality,and an inverse J-shaped association with cardiovascular mortality.These patterns were consistent in both elderly men and women.The HDL-C levels associated with the lowest risk were 56 mg/dl(95%CI 53-59 mg/dl)for all-cause mortality,54 mg/dl(95%CI 51-57 mg/dl)for cardiovascular mortality,and 59 mg/dl(95%CI 56-62 mg/dl)for non-cardiovascular mortality.Subgroup analyses showed no significant effect modifications.Sensitivity analyses confirmed the primary findings.Conclusions In the elderly population,extremely high HDL-C levels increase the risks of all-cause mortality and non-cardiovascular mortality,but do not elevate cardiovascular mortality.The risk of all-cause mortality is the lowest at an HDL-C concentration of 56 mg/dl.关键词
高密度脂蛋白胆固醇/老年/全因死亡/心血管死亡Key words
high-density lipoprotein cholesterol/elderly/all-cause mortality/cardiovascular mortality分类
医药卫生引用本文复制引用
吕月,付治卿,安莉,李珊..高密度脂蛋白胆固醇与老年人群全因死亡和原因特异性死亡的关联:一项前瞻性队列研究[J].解放军医学杂志,2025,50(9):1089-1096,8.基金项目
This work was supported by the National Clinical Research Centre for Geriatric Diseases Open Project(NCRCG-PLAGH-2024016) 国家老年疾病临床医学研究中心开放课题(NCRCG-PLAGH-2024016) （NCRCG-PLAGH-2024016）
