High-density lipoprotein cholesterol and all-cause and cause-specific mortality among the elderly.

CONTEXT: The patterns of the association between high-density lipoprotein cholesterol (HDL-C) concentrations and mortality among the elderly are still unclear.

OBJECTIVE: To examine the association of HDL-C concentrations with mortality, and to identify the optimal HDL-C concentration range that predicts the lowest risk of all-cause mortality among the elderly.

DESIGN: This was a nationwide, community-based prospective cohort study.

METHODS: This study included 7,766 elderly individuals (aged ≥65 years; mean age: 74.4 years) from the Health and Retirement Study. Cox proportional hazards models and Cox models with penalized smoothing splines were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause and cause-specific mortality.

RESULTS: During a median follow-up of 5.9 years, 1,921 deaths occurred. After fully adjustment for covariates, a nonlinear (P for nonlinearity<0.001) association was found between HDL-C and all-cause mortality (minimum mortality risk at 71 mg/dL [1.84 mM]); the risk for all-cause mortality was significantly higher in the group with HDL-C concentration <61 mg/dL (1.58 mM) (HR: 1.18; 95% CI: 1.05-1.33) and in the group with HDL-C concentration >87 mg/dL (2.25 mM) (HR: 1.56; 95% CI: 1.17-2.07) than in the group with HDL-C concentrations ranging from 61 to 87 mg/dL (1.58-2.25 mM). Nonlinear associations of HDL-C concentrations with both cardiovascular and non-cardiovascular mortality were also observed (both P for nonlinearity<0.001).

CONCLUSIONS: Among the elderly, nonlinear associations were found between HDL-C and all-cause and cardiovascular mortality. The single optimal HDL-C concentration and range were 71 mg/dL and 61 to 87 mg/dL, respectively.