AUTHOR=Cheng Qi , Liu Xiao-cong , Chen Chao-lei , Huang Yu-qing , Feng Ying-qing , Chen Ji-yan 

TITLE=The U-Shaped Association of Non-High-Density Lipoprotein Cholesterol Levels With All-Cause and Cardiovascular Mortality Among Patients With Hypertension

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.707701

DOI=10.3389/fcvm.2021.707701

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> Non-high-density lipoprotein cholesterol (non-HDL-C) is a valuable indicator in routine blood lipid tests, but the associations of non-HDL-C with mortality in hypertensive population still remain uncertain.</p><p><bold>Methods:</bold> In the National Health and Nutrition Examination Surveys from 1999 to 2014, participants having hypertension were included and grouped by non-HDL-C levels (&lt;130, 130–159, 160–189, 190–219, and ≥220 mg/dl). Multivariate Cox regression was conducted for calculation of hazard ratios (HR) and 95% confidence interval (CI). To reveal the relationship between non-HDL-C and mortality, Kaplan–Meier survival curves, restricted cubic spline, linear regression, and subgroup analysis were also applied.</p><p><bold>Results:</bold> A total of 12,169 participants (47.52% males, mean age 57.27 ± 15.79 years) were included. During average follow-up of 92.5 months, 1,946 (15.99%) all-cause deaths and 422 (3.47%) cardiovascular deaths occurred. After adjusting for confounders, the association of non-HDL-C with mortality was detected as U-shaped. Threshold values were observed at 158 mg/dl for all-cause mortality and 190 mg/dl as to cardiovascular mortality. Below the threshold, every 10 mg/dl increment in non-HDL-C attributed to relatively low all-cause mortality significantly (HR = 0.94, 95% CI: 0.92–0.96). Above the threshold, non-HDL-C has significant positive associations with both all-cause (HR = 1.03, 95% CI: 1.01–1.05) and cardiovascular mortality (HR = 1.09, 95% CI: 1.05–1.14). For subgroups analysis, similar results were found among participants age &lt;65 years old, non-white population, those were not taking lipid-lowering drugs, and subjects with body mass index (BMI) ≥25 kg/m<sup>2</sup>.</p><p><bold>Conclusion:</bold> The U-shaped association was detected between non-HDL-C and mortality among hypertensive population.</p>