Endocrinol Metab.  2022 Apr;37(2):303-311. 10.3803/EnM.2021.1332.

Repeated Low High-Density Lipoprotein Cholesterol and the Risk of Thyroid Cancer: A Nationwide Population- Based Study in Korea

• Kim J
• Kim MK
• Baek KH
• Song KH
• Han K
• Kwon HS

• KMID: 2529222
• DOI: http://doi.org/10.3803/EnM.2021.1332

Abstract

Background
High-density lipoprotein cholesterol (HDL-C) plays an important role in the reverse cholesterol transport pathway and prevents atherosclerosis-mediated disease. It has also been suggested that HDL-C may be a protective factor against cancer. However, an inverse correlation between HDL-C and cancer has not been established, and few studies have explored thyroid cancer.
Methods
The study participants received health checkups provided by the Korean National Health Insurance Service from 2009 to 2013 and were followed until 2019. Considering the variability of serum HDL-C level, low HDL-C level was analyzed by grouping based on four consecutive health checkups. The data analysis was performed using univariate and multivariate Cox proportional hazard regression models.
Results
A total of 3,134,278 total study participants, thyroid cancer occurred in 16,129. In the crude model, the hazard ratios for the association between repeatedly measured low HDL-C levels and thyroid cancer were 1.243, 1.404, 1.486, and 1.680 (P for trend <0.01), respectively, which were significant even after adjusting for age, sex, lifestyle factors, and metabolic diseases. The subgroup analysis revealed that low HDL-C levels likely had a greater impact on the group of patients with central obesity (P for interaction= 0.062), high blood pressure (P for interaction=0.057), impaired fasting glucose (P for interaction=0.051), and hyperlipidemia (P for interaction=0.126).
Conclusion
Repeatedly measured low HDL-C levels can be considered a risk factor for cancer as well as vascular disease. Low HDL-C levels were associated with the risk of thyroid cancer, and this correlation was stronger in a metabolically unhealthy population.

Keyword

Thyroid neoplasms; Lipid metabolism; Cholesterol, HDL

Figure

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  Fig. 1. Flow chart of the study population.

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  Fig. 2. Definition of groups for the statistical analysis. HDL-C, high-density lipoprotein cholesterol.

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  Fig. 3. The cumulative effect of low high-density lipoprotein cholesterol levels on the incidence of thyroid cancer.

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