AUTHOR=Wu Wanqing , Xiao Zhenxu , Liang Xiaoniu , Zhao Qianhua , Luo Jianfeng , Ding Ding 

TITLE=Low and High-Density Lipoprotein Cholesterol and 10-Year Mortality in Community-Dwelling Older Adults: The Shanghai Aging Study

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.783618

DOI=10.3389/fmed.2022.783618

ISSN=2296-858X

ABSTRACT=Background
The relationship between serum cholesterol and mortality remains disputed. This study aimed to examine the association of low and high-density lipoprotein cholesterol (LDL-C and HDL-C) with all-cause mortality among community-dwelling older adults in the Shanghai Aging Study. 

Methods 
We followed 3239 participants free of lipid-lowering agents for a median of 10 years. Levels of LDL-C and HDL-C were measured at baseline using fasting blood samples. Survival status was confirmed by the local mortality surveillance system. The associations between the levels of LDL-C, HDL-C, and all-cause were assessed by Cox proportional hazards models.

Results
The increment of LDL-C concentration was related to a lower risk of mortality (p for trend<0.001). Using the highest quintile of LDL-C (≥4.10 mmol/L) as a reference, the lowest quintile of LDL-C (<2.61mmol/L) was associated with the highest risk of mortality, after adjusting for confounders (HR 1.67; 95% CI 1.26-2.21), and further exclusion of death within the first two years of follow-up (HR 1.57; 95% CI 1.17-2.11). A U-shape relationship was found between HDL-C level and the mortality risk. Using the third quintile of HDL-C (1.21-1.39 mmol/L) as a reference, HR (95% CI) was 1.46 (1.09-1.95) for the lowest quintile (<1.09 mmol/L) and 1.45 (1.07-1.96) for the highest quintile (≥1.61 mmol/L) of HDL-C, after adjusting for confounders; and 1.57 (1.15-2.15) for the lowest quintile and 1.45 (1.04-2.01) for the highest quintile of HDL-C, after further exclusion of death within the first two years of follow-up.

Conclusions 
We found an inverse association of LDL-C and a U-shape relationship of HDL-C with long-term all-cause mortality in a cohort with older community-dwelling Chinese adults. Levels of LDL-C and HDL-C are suggested to be managed properly in late life.