What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=12169). Intervention: Non-high-density lipoprotein cholesterol (non-HDL-C) vs. Baseline non-HDL-C. Primary outcome: All-cause mortality (per 10 mg/dl increment above 158 mg/dl) (HR 1.03, 95% CI 1.01-1.05, p=0.013).

July 14, 2021Open Access

The U-Shaped Association of Non-High-Density Lipoprotein Cholesterol Levels With All-Cause and Cardiovascular Mortality Among Patients With Hypertension

Q: What does this research mean for the field?

Non-HDL-C exhibits a U-shaped association with mortality in hypertensive patients, with levels above 158 mg/dl increasing all-cause mortality risk by 3% per 10 mg/dl increment. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Non-HDL-C exhibited a U-shaped association with mortality in hypertensive patients, with levels above 158 mg/dl increasing all-cause mortality risk by 3% per 10 mg/dl increment (HR 1.03).

Study Design

Type

Cohort (n=12,169)

Multicenter

Yes

Structured PICO

Is there an association between non-HDL-C levels and all-cause or cardiovascular mortality in patients with hypertension?

Population

12,169 participants with hypertension from the National Health and Nutrition Examination Surveys (1999-2014), mean age 57.27 ± 15.79 years, 47.52% male.

Intervention

Non-HDL-C levels (categorized as <130, 130–159, 160–189, 190–219, and ≥220 mg/dl)

Comparator

Different categories of non-HDL-C levels

Outcome

All-cause and cardiovascular mortalityhard clinical

In hypertensive patients, non-HDL-C exhibits a U-shaped association with mortality, suggesting both very low and high levels may be associated with increased risk.

Main Result

Effect estimate: HR 1.03 (95% CI 1.01-1.05)

p-value: p=0.013

Limitations

Smoking status and current medication treatment were self-reported, which may cause recall bias.
Blood lipid levels were only measured once at baseline and may have changed during follow-up.
Findings are applicable to the North American population and may not be generalizable to other regions.

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, and ≥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. During average follow-up of 92.5 months, 1,946 (15.99%) all-cause deaths and 422 (3.47%) cardiovascular deaths occurred. After adjusting for confounders, the association of non-HDL-C with mortality was detected as U-shaped. Threshold values were observed at 158 mg/dl for all-cause mortality and 190 mg/dl as to cardiovascular mortality. Below the threshold, every 10 mg/dl increment in non-HDL-C attributed to relatively low all-cause mortality significantly (HR = 0.94, 95% CI: 0.92–0.96). Above the threshold, non-HDL-C has 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 body mass index (BMI) ≥25 kg/m 2 . Conclusion: The U-shaped association was detected between non-HDL-C and mortality among hypertensive population.

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