Non-HDL cholesterol paradox and effect of underlying malnutrition in patients with coronary artery disease: A 41,182 cohort study

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 41; no. 3; pp. 723 - 730
• Main Authors: Wang, Bo, Guo, Zhaodong, Li, Huanqiang, Zhou, Ziyou, Lu, Hongyu, Ying, Ming, Mai, Ziling, Yu, Yaren, Yang, Yongquan, Deng, Jingru, Chen, Jiyan, Tan, Ning, Liu, Jin, Liu, Yong, Chen, Shiqun
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-03-2022
• Subjects: Cholesterol; Cholesterol, HDL; Cholesterol, LDL; Cohort Studies; Coronary artery disease; Coronary Artery Disease - complications; Coronary Artery Disease - epidemiology; Humans; Long-term all-cause mortality; Malnutrition; Malnutrition - epidemiology; Non-high-density lipoprotein cholesterol; Paradox; Risk Factors; Triglycerides; Paradox; Malnutrition; Non-high-density lipoprotein cholesterol; Coronary artery disease; Long-term all-cause mortality
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2022.01.027

Non-high-density lipoprotein cholesterol (non-HDL-C) and low-density lipoprotein cholesterol (LDL-C) were established as the target for blood lipid management among patients with coronary artery disease (CAD). Previous study reported a negative relation between baseline LDL-C levels and long-term prognosis. However, the association between baseline non-HDL-C concentration and clinical outcomes is unknown.
A total of 41,182 CAD patients admitted to Guangdong Provincial People's Hospital in China were included in this study from January 2007 to December 2018 and divided into two groups (non-HDL-C < 2.2 mmol/L, n = 3236; non-HDL-C ≥ 2.2 mmol/L, n = 37,946). The Kaplan–Meier method, Cox regression analyses and restricted cubic splines were used to assess the association between non-HDL-C levels and long-term all-cause mortality.
The overall mortality was 12.74% (n = 5247) over a median follow-up period of 5.20 years. Kaplan–Meier analysis showed that low non-HDL-C levels were paradoxically associated with a worse prognosis. After adjustment for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that low non-HDL-C levels (<2.2 mmol/L) were not significantly associated with all-cause mortality (adjusted HR, 1.03; 95% CI, 0.93–1.14). After adjustment for nutritional status, the risk of all-cause mortality in patients with low non-HDL-C levels decreased (adjusted HR, 0.86; 95% CI, 0.78–0.95). In the final multivariate Cox model adjusting for full covariates, low non-HDL-C level was related to better prognosis (adjusted HR, 0.88; 95% CI, 0.80–0.98).
This study found a paradoxical association between baseline non-HDL-C concentration and long-term all-cause mortality. Malnutrition mainly mediates to the non-HDL-C paradox. Elevated non-HDL-C concentration is still a risk factor of long-term all-cause mortality after considering nutritional status.