Non-HDL cholesterol paradox and effect of underlying malnutrition in patients with coronary artery disease: A 41,182 cohort study.

Abstract

BACKGROUND & AIMS:

Non-high-density lipoprotein cholesterol (non-HDL-C) and low-density lipoprotein cholesterol (LDL-C) were established as the target for blood lipid management among patients with coronary artery disease (CAD). Previous study reported a negative relation between baseline LDL-C levels and long-term prognosis. However, the association between baseline non-HDL-C concentration and clinical outcomes is unknown.

METHODS:

A total of 41,182 CAD patients admitted to Guangdong Provincial People's Hospital in China were included in this study from January 2007 to December 2018 and divided into two groups (non-HDL-C < 2.2 mmol/L, n = 3236; non-HDL-C ≥ 2.2 mmol/L, n = 37,946). The Kaplan-Meier method, Cox regression analyses and restricted cubic splines were used to assess the association between non-HDL-C levels and long-term all-cause mortality.

RESULTS:

The overall mortality was 12.74% (n = 5247) over a median follow-up period of 5.20 years. Kaplan-Meier analysis showed that low non-HDL-C levels were paradoxically associated with a worse prognosis. After adjustment for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that low non-HDL-C levels (<2.2 mmol/L) were not significantly associated with all-cause mortality (adjusted HR, 1.03; 95% CI, 0.93-1.14). After adjustment for nutritional status, the risk of all-cause mortality in patients with low non-HDL-C levels decreased (adjusted HR, 0.86; 95% CI, 0.78-0.95). In the final multivariate Cox model adjusting for full covariates, low non-HDL-C level was related to better prognosis (adjusted HR, 0.88; 95% CI, 0.80-0.98).

CONCLUSION:

This study found a paradoxical association between baseline non-HDL-C concentration and long-term all-cause mortality. Malnutrition mainly mediates to the non-HDL-C paradox. Elevated non-HDL-C concentration is still a risk factor of long-term all-cause mortality after considering nutritional status.

• Authors: Bo Wang, Zhaodong Guo, Huanqiang Li, Ziyou Zhou, Hongyu Lu, Ming Ying, Ziling Mai, Yaren Yu, Yongquan Yang, Jingru Deng, Jiyan Chen, Ning Tan, Jin Liu, Yong Liu, Shiqun Chen
• Journal: Clinical nutrition (Edinburgh, Scotland) (Clin Nutr) Vol. 41 Issue 3 Pg. 723-730 (03 2022) ISSN: 1532-1983 [Electronic] England
• PMID: 35168005 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Cholesterol, HDL
• Cholesterol, LDL
• Triglycerides
• Cholesterol

Topics

• Cholesterol
• Cholesterol, HDL
• Cholesterol, LDL
• Cohort Studies
• Coronary Artery Disease (complications, epidemiology)
• Humans
• Malnutrition (epidemiology)
• Risk Factors
• Triglycerides