Low and Decreasing Cholesterol Levels and Risk of All-Cause and Cause-Specific Mortality: A Prospective and Longitudinal Cohort Study

作者：Qin Jiang, Jiachen Wu, Yuan Yu, Xingjie Hao, Pinpin Long, Kang Liu, Shihe Liu, Rong Peng, Kuai Yu, Rui Zeng, Shuohua Chen, Handong Yang, Xiulou Li, Xiaomin Zhang, Meian He, Lin Wang, Xiang Cheng, An Pan, Shouling Wu, Chaolong Wang, Tangchun Wu · 发表于：Engineering · 年份：2025 · DOI：10.1016/j.eng.2025.06.032 · 被引用次数：2 · 研究领域：Lipoproteins and Cardiovascular Health、Diabetes, Cardiovascular Risks, and Lipoproteins、Health Systems, Economic Evaluations, Quality of Life

This prospective study aimed to investigate the associations of untreated cholesterol levels and their longitudinal changes, especially low levels, with all-cause and cause-specific mortality in different populations. Participants were drawn from two Chinese cohorts and the UK Biobank, excluding those with lipid-lowering medications, coronary heart disease (CHD), stroke, cancer, clinically diagnosed chronic obstructive pulmonary disease, low body mass index (< 18.5 kg∙m –2 ) at baseline, and deaths within the first two years to minimize reverse causality. Individual cholesterol changes were assessed in a subset who attended the resurvey after over four years. Mortality data were linked to registries, and risks were estimated using Cox proportional hazards models. A total of 163 115 Chinese and 317 305 UK adults were included (mean age, 49–61 years), with 43%, 81%, and 44% males in Dongfeng–Tongji, Kailuan, and UK Biobank cohorts, respectively. During a median follow-up of 9.7–12.9 years, 9 553 and 15 760 deaths were documented in the Chinese cohorts and UK Biobank, respectively. After multivariate adjustments, nonlinear relationships were observed between total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C) levels and mortality. In both populations, high cholesterol was primarily associated with CHD mortality, while low cholesterol associated with all-cause and cancer mortality ( P nonlinear ≤ 0.0161). T...