Impact of non-high-density lipoprotein cholesterol on all-cause and cause-specific mortality in the elderly over 60 years old

Fu Zhiqing; Bai Yongyi; An Li; Zhang Wei; Lai Song; Li Shan

doi:10.3969/j.issn.1009-0126.2025.07.004

Abstract：Objective To determine the effect of non-high-density lipoprotein cholesterol(non-HDL-C)on all-cause and cause-specific mortality in an ≥60-year-old elderly population.Methods A total of 16 642 older adults(≥60 years)were subjected from the National Health and Nutrition Examination Survey between 1999 and 2018.According to the tertile of non-HDL-C level,the par-ticipants were divided into tertile 1(＜3.15 mmol/L,n=5499),tertile 2(3.15-4.06 mmol/L,n=5499),and tertile 3 groups(＞4.06 mmol/L,n=5644).The occurrences of all-cause,cardiovascu-lar,and non-cardiovascular death were identified as the study endpoint.Cox proportional hazards regression,Kaplan-Meier survival and restricted cubic spline curve analyses were applied for sta-tistical study.Results An obvious L-shaped associations were observed in non-HDL-C level with risks for all-cause,cardiovascular,and non-cardiovascular death.After adjusting multivariable,the tertile 1 group had significantly higher risks for all-cause,cardiovascular,and non-cardiovascular death than the tertile 2 group(HR=1.123,95％CI:1.054-1.200,P=0.000;HR=1.142,95％CI:1.024-1.292,P=0.027;HR=1.113,95％CI:1.033-1.210,P=0.011).Kaplan-Meier survival analysis showed that the tertile 1 group had notably lower survival rate than the tertile 2 group and the tertile 3 group(P＜0.01).Threshold effect analysis revealed that when non-HDL-C level was lower than 3.36,3.18 and 3.59 mmol/L,respectively,the risk of all-cause,cardiovascular,and noncardiovascular mortality was increased.Conclusion In the elderly ≥60-year-old population,non-HDL-C level exhibited a L-shaped association with all-cause and cause-specific mortality,and＞3.18 mmol/L is regarded as a rational range.