Sex-Specific Relationships between HDL-Cholesterol Levels and 10-Year Mortality in Individuals with Atherosclerotic Cardiovascular Disease: A Nationwide Cohort Study of South Koreans
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources
2.2. Study Design and Subject Selection
2.3. Definitions and Models
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Sex-Stratified Three-Group Comparisons of 10-Year All-Cause Mortality
3.3. Hazard Ratios for 10-Year All-Cause Mortality
3.4. Distribution of 10-Year Mortality Stratified by Baseline HDL-C Levels
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total | Male | Female | p Value | |
---|---|---|---|---|
Number of subjects, n (% of total cohort) | 1,711,548 (100) | 790,040 (46.2) | 921,508 (53.8) | _ |
Age, years | 61.4 ± 10.3 | 60.7 ± 10.3 | 62.1 ± 10.3 | <0.0001 |
40–49 years, n (%) | 227,898 (13.3) | 122,244 (15.5) | 105,654 (11.5) | <0.0001 |
50–59 years, n (%) | 521,167 (30.5) | 246,790 (31.2) | 274,377 (29.3) | |
60–69 years, n (%) | 533,907 (31.2) | 242,738 (30.7) | 291,169 (31.6) | |
70–79 years, n (%) | 361,140 (21.1) | 151,911 (19.2) | 209,229 (22.7) | |
≥80 years, n (%) | 67,436 (3.9) | 26,357 (3.3) | 41,079 (4.5) | |
BMI, kg/m2 | 24.47 ± 3.79 | 24.46 ± 2.97 | 24.48 ± 4.36 | <0.0001 |
Obesity, n (%) | 691,695 (40.4) | 322,504 (40.8) | 369,191 (40.1) | <0.0001 |
Abd. obesity, n (%) | 540,209 (31.6) | 247,495 (31.3) | 292,714 (31.8) | <0.0001 |
Smoking, n (%) | ||||
Never | 1,164,024 (68.2) | 278,817 (35.4) | 885,207 (96.3) | <0.0001 |
Past | 291,584 (17.1) | 271,184 (35.7) | 10,400 (1.1) | |
Current | 252,169 (14.8) | 228,484 (29.0) | 23,685 (2.6) | |
Alcohol, n (%) | ||||
None | 1,163,813 (68.2) | 355,762 (45.1) | 808,051 (87.9) | <0.0001 |
1 time/week | 205,152 (12.0) | 138,401 (17.6) | 66,751 (7.3) | |
2 times/week | 135,159 (7.9) | 112,196 (14.2) | 22,963 (2.5) | |
≥3 times/week | 203,297 (11.9) | 181,860 (23.1) | 21,437 (2.3) | |
Systolic BP, mmHg | 127.3 ± 15.7 | 128.0 ± 15.1 | 126.7 ± 16.1 | <0.0001 |
Diastolic BP, mmHg | 78.1 ± 10.0 | 78.9 ± 9.9 | 77.4 ± 10.0 | <0.0001 |
Hypertension, n (%) | 1,044,507 (61.0) | 497,307 (63.0) | 547,200 (59.4) | <0.0001 |
DM, n (%) | 399,287 (23.3) | 210,225 (26.6) | 189,062 (20.5) | <0.0001 |
FBS, mg/dL | 98 [89–110] | 99 [90–114] | 96 [88–107] | <0.0001 |
Blood test at baseline | ||||
sCr, mg/dL | 0.9 [0.8–1.0] | 1.0 [0.9–1.1] | 0.8 [0.7–0.9] | <0.0001 |
TC, mg/dL | 194 [168–220] | 187 [162–212] | 199 [174–226] | <0.0001 |
LDL-C, mg/dL | 112 [89–137] | 107 [84–130] | 117 [94–142] | <0.0001 |
HDL-C, mg/dL | 51 [44–61] | 49 [42–58] | 54 [46–63] | <0.0001 |
Triglycerides, mg/dL | 122 [86–175] | 128 [90–186] | 117 [84–166] | <0.0001 |
Non-HDL-C, mg/dL | 140 [116–167] | 136 [112–162] | 144 [120–171] | <0.0001 |
Sex | Male | Female | ||||||
---|---|---|---|---|---|---|---|---|
Groups | Low (N = 142,893) | High (N = 640,800) | Extremely High (N = 6347) | p Value | Low (N = 334,453) | High (N = 574,941) | Extremely High (N = 12,114) | p Value |
Age, years | 61.3 ±10.4 | 60.5 ±10.3 | 61.5 ±10.1 | <0.0001 † | 63.7 ±10.2 | 61.3 ±10.2 | 59.7 ±10.4 | <0.0001 * |
40–49 years, n (%) | 20,436 (14.3) | 101,005 (15.8) | 803 (12.7) | <0.0001 * | 29,538 (8.8) | 74,137 (12.9) | 1979 (16.3) | <0.0001 * |
50–59 years, n (%) | 43,114 (30.2) | 201,757 (31.5) | 1919 (30.2) | 86,503 (25.9) | 183,488 (31.9) | 4386 (36.2) | ||
60–69 years, n (%) | 43,616 (30.5) | 197,005 (30.7) | 2117 (33.4) | 110,614 (33.1) | 177,331 (30.8) | 3224 (26.6) | ||
70–79 years, n (%) | 30,185 (21.1) | 120,434 (18.8) | 1292 (20.4) | 88,328 (26.4) | 118,803 (20.7) | 2098 (17.3) | ||
≥80 years, n (%) | 5542 (3.9) | 20,599 (3.2) | 216 (3.4) | 19,470 (5.8) | 21,182 (3.7) | 427 (3.5) | ||
BMI, kg/m2 | 25.1 ±2.9 | 24.3 ±3.0 | 22.8 ±3.1 | <0.0001 * | 24.8 ±5.8 | 24.3 ±3.3 | 23.4 ±3.4 | <0.0001 * |
Obesity, n (%) | 70,045 (49.1) | 251,065 (39.2) | 1394 (22.0) | <0.0001 * | 148,502 (44.5) | 217,241 (37.8) | 3448 (28.5) | <0.0001 * |
Abd. obesity, n (%) | 56,497 (39.6) | 189,853 (29.6) | 1145 (18.0) | <0.0001 * | 123,811 (37.1) | 166,292 (28.9) | 2611 (21.6) | <0.0001 * |
Smoking, n (%) | ||||||||
Never | 49,534 (34.7) | 227,058 (35.5) | 2225 (35.1) | <0.0001 † | 320,843 (96.1) | 552,874 (96.4) | 11,490 (95.0) | <0.0001 * |
Past | 48,475 (34.0) | 230,583 (36.1) | 2126 (33.5) | 3732 (1.1) | 6476 (1.1) | 192 (1.6) | ||
Current | 44,583 (31.3) | 181,912 (28.4) | 1989 (31.4) | 9496 (2.8) | 14,081 (2.5) | 408 (3.4) | ||
Alcohol, n (%) | ||||||||
None | 81,074 (56.9) | 273,028 (42.7) | 1660 (26.3) | <0.0001 * | 305,653 (91.6) | 493,298 (86.0) | 9100 (75.5) | <0.0001 * |
1 time/week | 25,139 (17.6) | 112,481 (17.6) | 781 (12.4) | 18,470 (5.5) | 46,960 (8.2) | 1321 (11.0) | ||
2 times/week | 15,893 (11.2) | 95,385 (14.9) | 981 (14.5) | 5133 (1.5) | 17,073 (3.0) | 757 (6.3) | ||
≥3 times/week | 20,471 (14.4) | 158,434 (24.8) | 2955 (46.8) | 4540 (1.4) | 16,018 (2.8) | 879 (7.3) | ||
Systolic BP, mmHg | 127.5 ±15.1 | 128.1 ±15.1 | 130.9 ±16.3 | <0.0001 * | 127.5 ±16.1 | 126.3 ±16.1 | 126.3 ±16.3 | <0.0001 ‡ |
Diastolic BP, mmHg | 78.3 ±10.0 | 79.0 ±9.9 | 80.6 ±10.4 | <0.0001 * | 77.5 ±10.0 | 77.2 ±10.0 | 77.8 ±10.3 | <0.0001 † |
Hypertension, n (%) | 94,843 (66.4) | 398,574 (62.2) | 3890 (61.3) | <0.0001 ‡ | 215,857 (64.5) | 325,151 (56.6) | 6192 (51.1) | <0.0001 * |
DM, n (%) | 47,168 (33.0) | 161,636 (25.2) | 1421 (22.4) | <0.0001 * | 84,362 (25.2) | 102,899 (17.9) | 1801 (14.9) | <0.0001 * |
Blood test at baseline | ||||||||
FBS, mg/dL | 101 [91–118] | 99 [90–113] | 100 [90–113] | <0.0001 ‡ | 97 [89–110] | 96 [88–106] | 95 [87–105] | <0.0001 * |
sCr, mg/dL | 1.0 [0.9–1.2] | 1.0 [0.9–1.1] | 1.0 [0.9–1.1] | <0.0001 * | 0.8 [0.7–0.9] | 0.8 [0.7–0.9] | 0.8 [0.7–0.9] | <0.0001 ‡ |
TC, mg/dL | 174 [149–199] | 189 [165–215] | 212 [188–239] | <0.0001 * | 191 [166–218] | 203 [179–230] | 224 [199–252] | <0.0001 * |
LDL-C, mg/dL | 102 [79–125] | 108 [85–131] | 91 [67–117] | <0.0001 * | 116 [93–141] | 118 [96–143] | 106 [82–133] | <0.0001 * |
HDL-C, mg/dL | 35 [32–38] | 52 [45–60] | 97 [93–105] | <0.0001 * | 43 [39–46] | 60 [54–67] | 97 [93–103] | <0.0001 * |
Triglycerides, mg/dL | 164 [115–237] | 121 [86–175] | 89 [64–129] | <0.0001 * | 145 [104–202] | 106 [77–145] | 83 [61–116] | <0.0001 * |
Non-HDL-C, mg/dL | 139 [115–165] | 135 [111–161] | 111 [86–138] | <0.0001 * | 149 [124–175] | 142 [118–168] | 125 [100–153] | <0.0001 * |
All Subjects | Total (N = 1,711,548) | Low (N = 477,346) | High (N = 1,215,741) | Extremely High (N = 18,461) | p Value |
---|---|---|---|---|---|
Total, n (%) | 218,252 (12.8) | 68,615 (14.4) | 147,243 (12.1) | 2394 (13.0) | <0.0001 * |
By age, n (% of each age subgroup) | |||||
40–49 years | 4379 (1.9) | 1037 (2.1) | 3248 (1.9) | 94 (3.4) | <0.0001 * |
50–59 years | 19,237 (3.7) | 4835 (3.7) | 14,108 (3.7) | 294 (4.7) | <0.0001 † |
60–69 years | 53,495 (10.0) | 15,091 (9.8) | 37,774 (10.1) | 630 (11.8) | <0.0001 * |
70–79 years | 99,699 (27.6) | 32,118 (27.1) | 66,577 (27.8) | 1004 (29.6) | <0.0001 * |
≥80 years | 41,442 (61.5) | 15,534 (62.1) | 25,536 (61.1) | 372 (57.9) | 0.0068 † |
Males | Total (N = 790,040) | Low (N = 142,893) | High (N = 640,800) | Extremely High (N = 6347) | p value |
Male, n (%) | 127,821 (16.2) | 27,782 (19.4) | 98666 (15.4) | 1373 (21.6) | <0.0001 * |
By age, n (% of each age subgroup) | |||||
40–49 years, n (%) | 3188 (2.6) | 631 (3.1) | 2498 (2.5) | 59 (7.3) | <0.0001 * |
50–59 years, n (%) | 13,695 (5.5) | 2824 (6.6) | 10,671 (5.3) | 200 (10.4) | <0.0001 * |
60–69 years, n (%) | 35,587 (14.7) | 7532 (17.3) | 27,651 (14.0) | 404 (19.1) | <0.0001 * |
70–79 years, n (%) | 56,710 (37.3) | 12,658 (41.9) | 43,492 (36.1) | 560 (43.3) | <0.0001 * |
≥80 years, n (%) | 18,641 (70.7) | 4137 (74.6) | 14,354 (69.7) | 150 (69.4) | <0.0001 ‡ |
Females | Total (N = 921,508) | Low (N = 334,453) | High (N = 574,941) | Extremely High (N = 12,114) | p value |
Female, n (%) | 90,431 (9.8) | 40,833 (12.2) | 48577 (8.4) | 1021 (8.4) | <0.0001 ‡ |
By age, n (% of each age subgroup) | |||||
40–49 years, n (%) | 1191 (1.1) | 406 (1.4) | 750 (1.0) | 35 (1.8) | <0.0001 * |
50–59 years, n (%) | 5542 (2.0) | 2011 (2.3) | 3437 (1.9) | 94 (2.1) | <0.0001 § |
60–69 years, n (%) | 17,908 (6.2) | 7559 (6.8) | 10,123 (5.7) | 226 (7.0) | <0.0001 || |
70–79 years, n (%) | 42,989 (20.5) | 19,460 (22.0) | 23,085 (19.4) | 444 (21.2) | <0.0001 || |
≥80 years, n (%) | 22,801 (55.5) | 11,397 (58.5) | 11,182 (52.8) | 222 (52.0) | <0.0001 ‡ |
Sex | Reference HDL-C | Group of HDL-C | Unadjusted HR (95% CI) | p Value | Adjusted HR * (95% CI) | p Value * |
---|---|---|---|---|---|---|
Male | 40–90 mg/dL | Low | 1.296 (1.279–1.314) | <0.0001 | 1.183 (1.166–1.199) | <0.0001 |
Extremely high | 1.464 (1.388–1.545) | <0.0001 | 1.359 (1.288–1.434) | <0.0001 | ||
Female | 50–90 mg/dL | Low | 1.472 (1.453–1.492) | <0.0001 | 1.153 (1.138–1.169) | <0.0001 |
Extremely high | 0.994 (0.934–1.053) | 0.853 | 1.095 (1.029–1.167) | 0.0041 |
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Yang, H.S.; Jeong, H.J.; Kim, H.; Lee, S.; Hur, M. Sex-Specific Relationships between HDL-Cholesterol Levels and 10-Year Mortality in Individuals with Atherosclerotic Cardiovascular Disease: A Nationwide Cohort Study of South Koreans. Metabolites 2023, 13, 1175. https://doi.org/10.3390/metabo13121175
Yang HS, Jeong HJ, Kim H, Lee S, Hur M. Sex-Specific Relationships between HDL-Cholesterol Levels and 10-Year Mortality in Individuals with Atherosclerotic Cardiovascular Disease: A Nationwide Cohort Study of South Koreans. Metabolites. 2023; 13(12):1175. https://doi.org/10.3390/metabo13121175
Chicago/Turabian StyleYang, Hyun Suk, Ho Jin Jeong, Hyeongsu Kim, Seungho Lee, and Mina Hur. 2023. "Sex-Specific Relationships between HDL-Cholesterol Levels and 10-Year Mortality in Individuals with Atherosclerotic Cardiovascular Disease: A Nationwide Cohort Study of South Koreans" Metabolites 13, no. 12: 1175. https://doi.org/10.3390/metabo13121175