Key result
High baseline LDL linked to ~26% lower risk of incident airflow obstruction vs low LDL.
Why the study?
Dyslipidemia may influence pulmonary function through systemic inflammation and metabolic dysfunction, but longitudinal evidence remains limited.
Do baseline LDL and HDL cholesterol levels affect lung function decline and risk of airflow obstruction in individuals without baseline airflow obstruction?
Cohort (n=7,381)
Do baseline LDL and HDL cholesterol levels affect lung function decline and risk of airflow obstruction in individuals without baseline airflow obstruction?
Elevated LDL cholesterol is associated with a slower decline in lung function and reduced risk of incident airflow obstruction, while higher HDL cholesterol may be linked to accelerated FEV1 decline.
Rationale Dyslipidemia may influence pulmonary function through shared mechanisms involving systemic inflammation and metabolic dysfunction, but longitudinal evidence remains limited. This study aimed to examine the associations of baseline low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol levels with lung function decline and incident airflow obstruction in a community-based cohort. Methods We analyzed data from 7,381 participants in the Korean Genome and Epidemiology Study, all without baseline airflow obstruction. Baseline LDL cholesterol was categorized as ≤ 130 mg/dL (LDL_low), 130-160 mg/dL (LDL_medium), and >160 mg/dL (LDL_high), while HDL cholesterol was classified as ≤ 50 mg/dL (HDL_low) and >50 mg/dL (HDL_high). Linear mixed-effects models were used to estimate annual changes in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) according to baseline lipid levels. Cox proportional hazards models were applied to evaluate the risk of incident airflow obstruction during follow-up, adjusting for potential confounders including age, sex, smoking status, body mass index, and comorbidities. Results Higher LDL cholesterol levels were associated with a slower annual decline in lung function. The annual FEV1 decline was −40.47 mL/year in the LDL_low group versus −36.65 mL/year in the LDL_high group (p < 0.001), with a similar pattern for FVC (−35.84 mL/year vs − 29.86 mL/year, p < 0.001). Participants in the LDL_high group had a significantly reduced risk of developing airflow obstruction (adjusted hazard ratio [aHR]=0.74, 95% confidence interval [CI]: 0.57-0.97) compared to those in the LDL_low group (Figure). Conversely, individuals in the HDL_high group experienced a more rapid FEV1 decline (−41.20 vs − 37.91 mL/year, p < 0.001), though differences in FVC decline and incident airflow obstruction were not statistically significant. Conclusion Elevated LDL cholesterol may have a protective association with lung function decline and the development of airflow obstruction, whereas higher HDL cholesterol levels may be linked to accelerated FEV1 decline. These findings highlight the complex relationship between lipid metabolism and respiratory outcomes, suggesting that lipid-related pathways may play a role in the progression of chronic airflow limitation.
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Choi et al. (2026) conducted a cohort in Lung function decline and airflow obstruction (n=7,381). High LDL cholesterol (>160 mg/dL) vs. Low LDL cholesterol (≤ 130 mg/dL) was evaluated on Incident airflow obstruction (aHR 0.74, 95% CI 0.57-0.97). High baseline LDL cholesterol (>160 mg/dL) was associated with a significantly reduced risk of incident airflow obstruction compared to low LDL cholesterol (≤130 mg/dL) (aHR 0.74; 95% CI 0.57-0.97).
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