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=Volume 8 - 2021

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=Background: 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. 
Methods: In the National Health and Nutrition Examination Surveys from 1999 to 2014, participants having hypertension were included and grouped by non-HDL-C levels (<130, 130-159, 160-189, 190-219, ≥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.
Results: A total of 12,169 participants (47.52% males, mean age 57.27 ±15.79 years) were included. 1,946 (15.99%) all-cause deaths and 422 (3.47%) cardiovascular deaths occurred during average follow-up of 92.5 months. After adjusting for confounders, the association of non-HDL-C with mortality was detected as U-shaped. Threshold values were observed at 158mg/dL for all-cause mortality and 190mg/dL as to cardiovascular mortality. Below the threshold, every 10mg/dL increment in non-HDL-C resulted in relatively low all-cause mortality significantly (HR=0.94, 95%CI: 0.92-0.96). Above the threshold, non-HDL-C have 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 <65 years old, non-white population, those were not taking lipid-lowering drugs and subjects with BMI ≥25 kg/m2.
Conclusion: The U-shaped association was detected between non-HDL-C and mortality among hypertensive population.