A nonlinear association of total cholesterol with all-cause and cause-specific mortality
Abstract Background The link between total cholesterol (TC) and all-cause and specific mortality has not been elucidated. Herein, we aimed to evaluate the effect of TC levels on all-cause, cardiovascular disease (CVD), and cancer mortality. Methods All data analyzed were obtained from the National H...
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doaj-9e9163f1888f4106918ae4cb715eaaa22021-03-11T12:47:34ZengBMCNutrition & Metabolism1743-70752021-03-0118111110.1186/s12986-021-00548-1A nonlinear association of total cholesterol with all-cause and cause-specific mortalityGuo-dong He0Xiao-cong Liu1Lin Liu2Yu-ling Yu3Chao-lei Chen4Jia-yi Huang5Kenneth Lo6Yu-qing Huang7Ying-qing Feng8Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Epidemiology, Centre for Global Cardio-Metabolic Health, Brown UniversityDepartment of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesDepartment of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesAbstract Background The link between total cholesterol (TC) and all-cause and specific mortality has not been elucidated. Herein, we aimed to evaluate the effect of TC levels on all-cause, cardiovascular disease (CVD), and cancer mortality. Methods All data analyzed were obtained from the National Health and Nutrition Examination Survey 1999–2014. The relationship between levels of TC and mortality was determined through Cox proportional hazard regression analysis coupled with multivariable adjustments. Two-piecewise linear regression models and Cox models with penalized splines were applied to explore nonlinear and irregular shape relationships. Kaplan–Meier survival curve and subgroup analyses were conducted. Results The sample studied comprised 14,662 men and 16,025 women, categorized as 25,429 adults aged 18–65 and 5,258 adults over 65 years old. A total of 2,570 deaths were recorded. All-cause, cardiovascular, and cancer mortality showed U-curve associations after adjusting for confounding variables in the restricted cubic spline analysis. Hazard ratios (HRs) of all-cause and cancer mortality were particularly negatively related to TC levels in the lower range < 200 mg/dL, especially in the range < 120 mg/dL (HR 1.97; 95% CI 1.38, 2.83, HR 2.39; 95% CI 1.21, 4.71, respectively). However, the HRs of cardiovascular disease mortality in the range < 120 mg/dL were the lowest (HR 0.60; 95% CI 0.15, 2.42). In the upper range, a TC range of ≥ 280 mg/dL was correlated with mortality as a result of CVD and cancer (HR 1.31; 95% CI 0.87, 1.97 and HR 1.22; 95% CI 0.82, 1.79). The lowest cumulative survival rate of all-cause mortality was recorded in the lowest TC-level group, while the lowest cumulative survival rate of CVD mortality was recorded in the highest TC-level group. Conclusions A nonlinear association of TC level with all-cause, cancer, and CVD mortality in the American population was observed, suggesting that too low or too high serum total cholesterol levels might correlate with adverse outcomes.https://doi.org/10.1186/s12986-021-00548-1Total cholesterolAll-cause mortalityCancerCardiovascular disease |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Guo-dong He Xiao-cong Liu Lin Liu Yu-ling Yu Chao-lei Chen Jia-yi Huang Kenneth Lo Yu-qing Huang Ying-qing Feng |
spellingShingle |
Guo-dong He Xiao-cong Liu Lin Liu Yu-ling Yu Chao-lei Chen Jia-yi Huang Kenneth Lo Yu-qing Huang Ying-qing Feng A nonlinear association of total cholesterol with all-cause and cause-specific mortality Nutrition & Metabolism Total cholesterol All-cause mortality Cancer Cardiovascular disease |
author_facet |
Guo-dong He Xiao-cong Liu Lin Liu Yu-ling Yu Chao-lei Chen Jia-yi Huang Kenneth Lo Yu-qing Huang Ying-qing Feng |
author_sort |
Guo-dong He |
title |
A nonlinear association of total cholesterol with all-cause and cause-specific mortality |
title_short |
A nonlinear association of total cholesterol with all-cause and cause-specific mortality |
title_full |
A nonlinear association of total cholesterol with all-cause and cause-specific mortality |
title_fullStr |
A nonlinear association of total cholesterol with all-cause and cause-specific mortality |
title_full_unstemmed |
A nonlinear association of total cholesterol with all-cause and cause-specific mortality |
title_sort |
nonlinear association of total cholesterol with all-cause and cause-specific mortality |
publisher |
BMC |
series |
Nutrition & Metabolism |
issn |
1743-7075 |
publishDate |
2021-03-01 |
description |
Abstract Background The link between total cholesterol (TC) and all-cause and specific mortality has not been elucidated. Herein, we aimed to evaluate the effect of TC levels on all-cause, cardiovascular disease (CVD), and cancer mortality. Methods All data analyzed were obtained from the National Health and Nutrition Examination Survey 1999–2014. The relationship between levels of TC and mortality was determined through Cox proportional hazard regression analysis coupled with multivariable adjustments. Two-piecewise linear regression models and Cox models with penalized splines were applied to explore nonlinear and irregular shape relationships. Kaplan–Meier survival curve and subgroup analyses were conducted. Results The sample studied comprised 14,662 men and 16,025 women, categorized as 25,429 adults aged 18–65 and 5,258 adults over 65 years old. A total of 2,570 deaths were recorded. All-cause, cardiovascular, and cancer mortality showed U-curve associations after adjusting for confounding variables in the restricted cubic spline analysis. Hazard ratios (HRs) of all-cause and cancer mortality were particularly negatively related to TC levels in the lower range < 200 mg/dL, especially in the range < 120 mg/dL (HR 1.97; 95% CI 1.38, 2.83, HR 2.39; 95% CI 1.21, 4.71, respectively). However, the HRs of cardiovascular disease mortality in the range < 120 mg/dL were the lowest (HR 0.60; 95% CI 0.15, 2.42). In the upper range, a TC range of ≥ 280 mg/dL was correlated with mortality as a result of CVD and cancer (HR 1.31; 95% CI 0.87, 1.97 and HR 1.22; 95% CI 0.82, 1.79). The lowest cumulative survival rate of all-cause mortality was recorded in the lowest TC-level group, while the lowest cumulative survival rate of CVD mortality was recorded in the highest TC-level group. Conclusions A nonlinear association of TC level with all-cause, cancer, and CVD mortality in the American population was observed, suggesting that too low or too high serum total cholesterol levels might correlate with adverse outcomes. |
topic |
Total cholesterol All-cause mortality Cancer Cardiovascular disease |
url |
https://doi.org/10.1186/s12986-021-00548-1 |
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