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Associations of HDL-C/LDL-C with myocardial infarction, all-cause mortality, haemorrhagic stroke and ischaemic stroke: a longitudinal study based on 384 093 participants from the UK Biobank

Shiqi Yuan, Xiaxuan Huang, Wen Ma, Rui Yang, Fengshuo Xu, Didi Han, Tao Huang, MIn Peng, Anding Xu, Jun Lyu
DOI: 10.1136/svn-2022-001668 Published 23 September 2022
Shiqi Yuan
1Department of Neurology, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
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Xiaxuan Huang
1Department of Neurology, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
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Wen Ma
2School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Rui Yang
2School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Fengshuo Xu
2School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Didi Han
2School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Tao Huang
3Department of Clinical Research, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
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MIn Peng
1Department of Neurology, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
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Anding Xu
1Department of Neurology, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
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  • ORCID record for Anding Xu
Jun Lyu
3Department of Clinical Research, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
4Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, Guangdong, China
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  • Figure 1
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    Figure 1

    Restricted cubic splines (RCS) for analysis of relationships between HDL-C (A), LDL-C (B), HDL-C/LDL-C (C) and different adverse events. (C) was adjusted for age, TDI, gender, race, smoking history, education level, alcohol use, BMI, BG, SBP, DBP and TG; (B) was adjusted for C+HDL C; a was adjusted for C+LDL. BG, blood glucose; DBP, diastolic blood pressure; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; MI, myocardial infarction; SBP, systolic blood pressure; TDI, Townsend Deprivation Index; TG, triglycerides.

  • Figure 2
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    Figure 2

    HRs estimation for all-cause mortality (A), MI (B), ischaemic stroke (C) and haemorrhagic stroke (D) among different HDL-C/LDL-C groups by Cox proportional risk model. *Variables used for adjustment included TDI, age, gender, race, smoking history, alcohol use, education level, BMI, BG, SBP, DBP and TG. BG, blood glucose; BMI, body mass index; DBP, diastolic blood pressure; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; MI, myocardial infarction; MV, multivariable; SBP, systolic blood pressure; TDI, Townsend Deprivation Index; TG, triglycerides.

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    Figure 3

    Joint correlation between CHD-GRS and HDL-C/LDL-C for myocardial infarction risk analysed using Cox proportional risk model. The multivariable model was adjusted for TDI, age, gender, race, smoking history, alcohol use, education level, BMI, BG, SBP, DBP and TG. BG, blood glucose; BMI, body mass index; CHD-GRS, coronary heart disease Genetic Risk Score; DBP, diastolic blood pressure; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; MI, myocardial infarction; SBP, systolic blood pressure; TDI, Townsend Deprivation Index; TG, triglycerides.

Tables

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  • Table 1

    Comparison of the basic characteristics between the survival group (n=361 031) and non-survival group (n=23 062)

    CharacteristicsSurvivors groupNon-Survivors groupP value
    Age, (median, IQR), years57 (50–63)63 (58–66)<0.001
     TDI (median, IQR)−2.2 (−3.7 to 0.4)−1.8 (−3.4 to 1.3)<0.001
    Gender (n, %)<0.001
     Female200 172 (55.4)9752 (42.3)
     Male160 859 (44.6)13 310 (57.7)
    Race (n, %)<0.001
     White326 335 (90.8)21 222 (92.6)
     Mixed13 315 (3.7)842 (3.7)
     Other19 713 (5.5)859 (3.7)
    Education (n, %)<0.001
     College/university119 466 (33.5)5573 (24.6)
     Other237 482 (66.5)17 107 (75.4)
    Smoking history (n, %)<0.001
     Never202 036 (56.2)9105 (39.8)
     Previous121 866 (33.9)9451 (41.3)
     Current35 437 (9.9)4306 (18.8)
    Alcohol use (n, %)<0.001
     Never15 614 (4.3)1122 (4.9)
     Previous11 897 (3.3)1430 (6.2)
     Current332 675 (92.4)20 434 (88.9)
    Myocardial infarction (n, %)<0.001
     No355 889 (98.6)21 472 (93.1)
     Yes5142 (1.4)1590 (6.9)
    Ischaemic stroke (n, %)<0.001
     No358 968 (99.4)22 161 (96.1)
     Yes2063 (0.6)901 (3.9)
    Haemorrhagic stroke (n, %)<0.001
     No360 499 (99.9)22 568 (97.9)
     Yes532 (0.1)494 (2.1)
    BMI (median, IQR), kg/m226.6 (24.1–29.8)27.4 (24.6–30.9)<0.001
    DBP (median, IQR), mm Hg82 (75–89)83 (75–90)<0.001
    SBP (median, IQR), mm Hg138 (126–152)144 (130–158)<0.001
    BG (median, IQR), mmol/L4.9 (4.6–5.3)5 (4.7–5.5)<0.001
    HDL-C (median, IQR), mmol/L1.4 (1.2–1.7)1.3 (1.1–1.6)<0.001
    TG (median, IQR), mmol/L1.5 (1–2.1)1.6 (1.1–2.3)<0.001
    LDL-C (median, IQR), mmol/L3.5 (3–4.1)3.4 (2.8–4.1)0.202
    • BG, blood glucose; BMI, body mass index; DBP, diastolic blood pressure; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; SBP, systolic blood pressure; TDI, Townsend Deprivation Index; TG, triglyceride.

  • Table 2

    HRs estimation for myocardial infarction, all-cause mortality and haemorrhagic and ischaemic stroke among different HDL-C/LDL-C groups by subgroup analyses of age-disaggregated and gender-disaggregated analyses

    SubgroupN0.4–0.6<0.4>0.6
    ReHR (95% CI)P valueHR (95% CI)P value
    Gender (model 1) 
     Female
      All-cause mortality9752Re0.99 (0.94 to 1.04)0.5861.15 (1.09 to 1.22)<0.001
      MI1948Re1.41 (1.26 to 1.57)<0.0011.12 (0.96 to 1.30)0.144
      Ischaemic stroke1178Re0.98 (0.86 to 1.13)0.8221.02 (0.85 to 1.22)0.822
      Haemorrhagic stroke537Re1.11 (0.90 to 1.36)0.3241.25 (0.97 to 1.59)0.079
     Male
      All-cause mortality13 310Re0.96 (0.92 to 1.00)<0.051.29 (1.21 to 1.37)<0.001
      MI4784Re1.31 (1.22 to 1.40)<0.0010.89 (0.77 to 1.01)0.077
      Ischaemic stroke1786Re1.2 (1.07 to 1.34)<0.011.11 (0.96 to 1.21)0.075
      Haemorrhagic stroke489Re0.87 (0.71 to 1.08)0.2191.32 (0.96 to 1.81)<0.05
    Age (model 2)
     <60 (years)
      All-cause mortality6876Re0.94 (0.89 to 1.00)<0.051.23 (1.13 to 1.33)<0.001
      MI2444Re1.66 (1.49 to 1.85)<0.0010.96 (0.79 to 1.16)0.657
      Ischaemic stroke867Re1.14 (0.96 to 1.34)0.1271.12 (0.87 to 1.45)0.362
      Haemorrhagic stroke390Re1.04 (0.81 to 1.33)0.7741.42 (1.03 to 1.94)<0.05
     ≥60 (years)
      All-cause mortality16 186Re0.98 (0.95 to 1.02)0.3821.19 (1.14 to 1.26)<0.001
      MI4288Re1.24 (1.16 to 1.33)<0.0010.97 (0.86 to 1.08)0.555
      Ischaemic stroke2097Re1.11 (1.00 to 1.22)<0.051.09 (0.94 to 1.26)0.256
      Haemorrhagic stroke636Re0.97 (0.81 to 1.17)0.7821.15 (0.9 to 1.48)0.264
    • HRs were estimated by Cox proportional risk model. Model 1 was adjusted for age, TDI, race, smoking history, education level, alcohol use, BMI, BG, SBP, DBP and TG; model 2 was the same as model 1 with the addition of adjustment for gender.

    • BG, blood glucose; BMI, body mass index; DBP, diastolic blood pressure; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; MI, myocardial infarction; Re, reference; SBP, systolic blood pressure; TDI, Townsend Deprivation Index; TG, triglycerides.

Supplementary Materials

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    [svn-2022-001668supp001.pdf]

Additional Files

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    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Data supplement 1
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Associations of HDL-C/LDL-C with myocardial infarction, all-cause mortality, haemorrhagic stroke and ischaemic stroke: a longitudinal study based on 384 093 participants from the UK Biobank
Shiqi Yuan, Xiaxuan Huang, Wen Ma, Rui Yang, Fengshuo Xu, Didi Han, Tao Huang, MIn Peng, Anding Xu, Jun Lyu
Stroke and Vascular Neurology Sep 2022, svn-2022-001668; DOI: 10.1136/svn-2022-001668

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Associations of HDL-C/LDL-C with myocardial infarction, all-cause mortality, haemorrhagic stroke and ischaemic stroke: a longitudinal study based on 384 093 participants from the UK Biobank
Shiqi Yuan, Xiaxuan Huang, Wen Ma, Rui Yang, Fengshuo Xu, Didi Han, Tao Huang, MIn Peng, Anding Xu, Jun Lyu
Stroke and Vascular Neurology Sep 2022, svn-2022-001668; DOI: 10.1136/svn-2022-001668
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Associations of HDL-C/LDL-C with myocardial infarction, all-cause mortality, haemorrhagic stroke and ischaemic stroke: a longitudinal study based on 384 093 participants from the UK Biobank
Shiqi Yuan, Xiaxuan Huang, Wen Ma, Rui Yang, Fengshuo Xu, Didi Han, Tao Huang, MIn Peng, Anding Xu, Jun Lyu
Stroke and Vascular Neurology Sep 2022, svn-2022-001668; DOI: 10.1136/svn-2022-001668
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