Purpose: Whether the paradox of high-density lipoprotein cholesterol (HDL-C) and elevated mortality risk extends to hypertensive patients is unclear. We aimed to investigate the association between HDL-C and all-cause and cardiovascular disease mortality in adults with hypertension.
Methods: In the National Health and Nutrition Examination Surveys, 11,497 hypertensive participants aged ≥ 18years old and examined at baseline between 1999 and 2014 were followed up until December 2015. We categorized the HDL-C concentration as ≤ 30, 31– 40, 41– 50, 51– 60 (reference), 61– 70, > 70 mg/dL and examined their associations with all-cause and cardiovascular mortality, respectively. Multivariate Cox regression was used to calculated hazard ratio (HR) and 95% confidence interval (CI) for mortality risk.
Results: During follow-up (median: 9.2 ± 3.8 years), 3012 deaths and 713 cardiovascular deaths were observed. In the restrictive cubic curves, associations of HDL-C levels and all-cause and cardiovascular mortality were detected to be U-shaped. After multivariable adjustment, HRs for all-cause mortality were for the lowest HDL-C concentration (≤ 30 mg/dL) 1.29 (95% CI, 1.07– 1.56) and the highest (> 70 mg/dL) 1.20 (1.06– 1.37), comparing with the reference group. For cardiovascular mortality, HRs were 1.31 (0.83– 1.48) and 1.09 (0.83– 1.43), respectively. Similar results were obtained in subgroups stratified by age, gender, race, and taking lipid-lowering drugs. The lowest all-cause mortality risk was observed at HDL-C 66 mg/dL (concentration) and 51– 60 mg/dL (range).
Conclusion: Both lower and higher HDL-C concentration appeared to be associated with higher mortality in hypertensive population. Further investigation is warranted to clarify the underlying mechanisms.
Keywords: all-cause mortality, high-density lipoprotein cholesterol, cardiovascular mortality, hypertension