한빛사 논문
Sang-Wook Yi,1* Sang Joon An,2 Hyung Bok Park,3 Jee-Jeon Yi4 and Heechoul Ohrr5
1Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea, 2Department of Neurology, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea, 3Department of Cardiology, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon, Republic of Korea, 4Institute for Occupational and Environmental Health, Catholic Kwandong University, Gangneung, Republic of Korea and 5Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
*Corresponding author.
Abstract
Background
Limited information is available on detailed sex/age-specific associations between low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease (CVD) mortality and ‘the optimal range’ associated with the lowest CVD mortality in the general population.
Methods
Korean adults (N = 14 884 975) who received routine health screenings during 2009–2010 were followed until 2018 for CVD mortality.
Results
During 8.8 years (mean) of follow-up, 94 344 individuals died from CVD. LDL-C had U-curve associations with mortality from CVD and its subtypes, except haemorrhagic stroke. Optimal range was 90–149 mg/dL for CVD; 70–114 for ischaemic heart disease; 85–129 for ischaemic stroke; ≥85 for subarachnoid haemorrhage; ≥130 for intracerebral haemorrhage; 115–159 for hypertension and heart failure; and 100–144 for sudden cardiac death. Assuming linear associations between 100 and 300 mg/dL, LDL-C was positively associated with CVD mortality [hazard ratio (HR) per 39-mg/dL (1-mmol/L) higher LDL-C = 1.10], largely due to ischaemic heart disease (HR = 1.26), followed by sudden cardiac death (HR = 1.13), ischaemic stroke (HR = 1.11) and heart failure (HR = 1.05). Intracerebral haemorrhage (HR = 0.90), but not subarachnoid haemorrhage, had inverse associations. Women and older adults had weaker positive associations than men and younger adults (Pinteraction < 0.001 for both sex and age). Individuals aged 75–84 years had modest positive associations with CVD mortality, especially ischaemic heart disease and ischaemic stroke.
Conclusion
LDL-C had U-curve associations for CVD mortality. The associations and optimal ranges differed across CVD subtypes. Women and older adults had weaker positive associations than men and younger adults. Positive associations with ischaemic heart disease and ischaemic stroke were maintained in adults aged 75–84 years.
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