Diabetes Metab J.  2023 Jan;47(1):59-71. 10.4093/dmj.2021.0320.

Association between Low-Density Lipoprotein Cholesterol Level and Cardiovascular Outcomes in Korean Adults: A Nationwide Cohort Study

• Noh J
• Moon MK
• Rhee EJ
• Park SH
• Kim HC
• Kim BJ
• Kim HJ
• Choi S
• Na JO
• Hyun YY
• Kim BJ
• Han KD
• Jeong IK
• on Behalf of the Committee of Practice Guideline of Korean Lipid and Atheroscelerosis

• KMID: 2538931
• DOI: http://doi.org/10.4093/dmj.2021.0320

Abstract

Background
To validate the treatment target of low-density lipoprotein cholesterol (LDL-C) level according to the cardiovascular disease (CVD) risk which was recommended by Korean dyslipidemia guideline.
Methods
We used the Korean National Health Insurance Service database which included 3,958,048 people aged 20 to 89 years who underwent regular health screening. The primary outcome was incident CVD, defined as a composite of myocardial infarction and stroke during the follow-up period from 2009 to 2018.
Results
The risk of CVD increased from LDL-C level of 70 mg/dL in very high-risk and high-risk groups and from 130 mg/dL in moderate-risk and low-risk groups. Adjusted hazard ratios (HRs) of LDL-C ranges 70–99, 100–129, 130–159, 160–189, and ≥190 mg/dL were 1.20 (95% confidence interval [CI], 1.08–1.33), 1.27 (1.15–1.42), 1.39 (1.23–1.56), 1.69 (1.45–1.96), and 1.84 (1.49– 2.27) in very high-risk group, and 1.07 (1.02–1.13), 1.16 (1.10–1.21), 1.29 (1.22–1.36), 1.45 (1.36–1.55), and 1.73 (1.58–1.90) in high-risk group. Adjusted HRs (95% CI) of LDL-C ranges 130–159, 160–189, and ≥190 mg/dL were 1.15 (1.11–1.20), 1.28 (1.22– 1.34), and 1.45 (1.36–1.54) in moderate-risk group and 1.07 (1.02–1.13), 1.20 (1.13–1.26), and 1.47 (1.37–1.57) in low-risk group.
Conclusion
We confirmed the incidence of CVD was increased in higher LDL-C range. The risk of CVD increased from ≥70 mg/dL of LDL-C in very high-risk and high-risk groups, and from ≥130 mg/dL of LDL-C in moderate-risk and low-risk groups in Korean adults.

Keyword

Cardiovascular diseases; Cholesterol; LDL; Korea

Figure

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  Fig. 1. Sensitivity analyses of association between the low-density lipoprotein cholesterol (LDL-C) and composite of myocardial infarction (MI) and stroke (A), MI (B), and stroke (C) stratified by cardiovascular disease risk categories; The LDL <70 mg/dL category was used as the reference for the model. Participants were divided into the following categories of LDL-C levels: <70 (reference), 70–99, 100–129, 130–159, 160–189, and ≥190 mg/dL. Hazard ratios (HRs) and 95% confidence intervals (CIs) of MI, and stroke according to the LDL-C levels. Adjusted for age, sex, body mass index, smoking, alcohol drinking, exercise, diabetes, hypertension, estimated glomerular filtration rate, fasting triglyceride level, and use of statins.

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