Total Cholesterol Variability and the Risk of Osteoporotic Fractures: A Nationwide Population-Based Cohort Study
Abstract
:1. Introduction
2. Methods
2.1. Dataset
2.2. Study Population
2.3. Assessment of Total Cholesterol Variability
2.4. Study Endpoints
2.5. Variables
2.6. Statistical Analysis
3. Results
3.1. Demographics and Clinical Characteristics
3.2. Association between Total Cholesterol Variability and Osteoporotic Fractures
3.3. Subgroup Analyses
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Total | Q1 | Q2 | Q3 | Q4 | p-Value |
---|---|---|---|---|---|---|
Number of participants (%) | 300,326 | 75,081 (25.0) | 75,082 (25.0) | 75,082 (25.0) | 75,081 (25.0) | |
Age, years | 56.25 ± 5.92 | 56.17 ± 5.89 | 55.75 ± 5.57 | 55.98 ± 5.69 | 57.11 ± 6.41 | <0.001 |
Sex | <0.001 | |||||
Male | 221,339 (73.7) | 57,057 (76.0) | 57,313 (76.3) | 55,397 (73.8) | 51,572 (68.7) | |
Female | 78,987 (26.3) | 18,024 (24.0) | 17,769 (23.7) | 19,685 (26.2) | 23,509 (31.3) | |
Body mass index (kg/m2) | 23.98 ± 2.76 | 23.93 ± 2.73 | 23.91 ± 2.72 | 23.94 ± 2.75 | 24.13 ± 2.85 | <0.001 |
Household income | <0.001 | |||||
Q1, lowest | 80,324 (26.7) | 18,443 (24.6) | 18,554 (24.7) | 20,248 (27.0) | 23,079 (30.7) | |
Q2 | 83,315 (27.7) | 19,805 (26.4) | 20,194 (26.9) | 21,123 (28.1) | 22,193 (29.6) | |
Q3 | 71,441 (23.8) | 18,058 (24.1) | 18,121 (24.1) | 17,934 (23.9) | 17,328 (23.1) | |
Q4, highest | 65,246 (21.7) | 18,775 (25.0) | 18,213 (24.3) | 15,777 (21.0) | 12,481 (16.6) | |
Smoking status | <0.001 | |||||
Never | 179,488 (59.8) | 43,722 (58.2) | 43,499 (57.9) | 45,013 (60.0) | 47,254 (62.9) | |
Former | 47,434 (15.8) | 12,676 (16.9) | 12,429 (16.6) | 11,625 (15.5) | 10,704 (14.3) | |
Current | 73,404 (24.4) | 18,683 (24.9) | 19,154 (25.5) | 18,444 (24.6) | 17,123 (22.8) | |
Alcohol consumption (days/week) | <0.001 | |||||
None | 200,543 (66.8) | 49,662 (66.1) | 49,269 (65.6) | 49,959 (66.5) | 51,653 (68.8) | |
1–4 | 90,419 (30.1) | 23,267 (31.0) | 23,667 (31.5) | 22,802 (30.4) | 20,683 (27.6) | |
≥5 | 9364 (3.1) | 2152 (2.9) | 2146 (2.9) | 2321 (3.1) | 2745 (3.7) | |
Regular physical activity (days/week) | <0.001 | |||||
None | 121,585 (40.5) | 29,165 (38.8) | 29,600 (39.4) | 30,347 (40.4) | 32,473 (43.3) | |
1–4 | 150,934 (50.3) | 39,025 (52.0) | 38,734 (51.6) | 37,922 (50.5) | 35,253 (47.0) | |
≥5 | 27,807 (9.3) | 6891 (9.2) | 6748 (9.0) | 6813 (9.1) | 7355 (9.8) | |
Comorbidities | ||||||
Hypertension | 114,971 (38.3) | 25,271 (33.7) | 25,546 (34.0) | 27,677 (36.9) | 36,477 (48.6) | <0.001 |
Diabetes mellitus | 58,940 (19.6) | 11,809 (15.7) | 12,276 (16.4) | 13,823 (18.4) | 21,032 (28.0) | <0.001 |
Dyslipidemia | 93,928 (31.3) | 16,905 (22.5) | 18,251 (24.3) | 22,175 (29.5) | 36,597 (48.7) | <0.001 |
Stroke | 7880 (2.6) | 1479 (2.0) | 1487 (2.0) | 1778 (2.4) | 3136 (4.2) | <0.001 |
Atrial fibrillation | 2739 (0.9) | 555 (0.7) | 521 (0.7) | 618 (0.8) | 1045 (1.4) | <0.001 |
Renal disease | 7700 (2.6) | 1386 (1.9) | 1445 (1.9) | 1707 (2.3) | 3162 (4.2) | <0.001 |
Cancer | 13,489 (4.5) | 2942 (3.9) | 3072 (4.1) | 3305 (4.4) | 4170 (5.6) | <0.001 |
On lipid-lowering agents | 29,287 (9.8) | 5410 (7.2) | 5658 (7.5) | 6874 (9.2) | 11,345 (15.1) | <0.001 |
Mean TC (mg/dL) | 198.66 ± 31.16 | 199.22 ± 28.61 | 198.02 ± 28.52 | 197.56 ± 29.09 | 199.84 ± 37.44 | <0.001 |
TC variability | ||||||
CV (%) | 10.11 ± 6.13 | 4.8 ± 1.3 | 7.81 ± 0.72 | 10.56 ± 0.93 | 17.28 ± 7.89 | <0.001 |
SD | 20.41 ± 23.66 | 9.57 ± 2.94 | 15.54 ± 2.65 | 20.89 ± 3.59 | 35.71 ± 42.84 | <0.001 |
VIM (%) | 21.22 ± 22.53 | 9.46 ± 2.86 | 15.45 ± 2.54 | 20.85± 3.51 | 35.68 ± 42.79 | <0.001 |
Multivariable Model (1) | Multivariable Model (2) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Number of Participants | Number of Events | Event Rate (%) (95% CI) | Person-Years | Incidence Rate (Per 1000 Person-Years) | Adjusted HR (95% CI) | p-Value | p-Value for Trend | Adjusted HR (95% CI) | p-Value | p-Value for Trend | |
CV | <0.001 | <0.001 | |||||||||
Q1 | 75,081 | 6704 | 8.93 (8.72, 9.14) | 874,299.98 | 7.67 | 1 (reference) | 1 (reference) | ||||
Q2 | 75,082 | 6603 | 8.79 (8.58, 9.01) | 874,827.89 | 7.55 | 1.02 (0.99, 1.06) | 0.230 | 1.02 (0.99, 1.05) | 0.282 | ||
Q3 | 75,082 | 7121 | 9.48 (9.26, 9.70) | 869,543.07 | 8.19 | 1.06 (1.03, 1.10) | <0.001 | 1.06 (1.02, 1.09) | 0.001 | ||
Q4 | 75,081 | 8616 | 11.48 (11.23, 11.72) | 852,157.80 | 10.11 | 1.11 (1.08, 1.15) | <0.001 | 1.10 (1.07, 1.14) | <0.001 | ||
SD | <0.001 | <0.001 | |||||||||
Q1 | 75,095 | 6767 | 9.01 (8.80, 9.23) | 872,764.30 | 7.75 | 1 (reference) | 1 (reference) | ||||
Q2 | 75,062 | 6522 | 8.69 (8.48, 8.90) | 874,326.38 | 7.46 | 0.99 (0.95, 1.02) | 0.459 | 0.99 (0.96, 1.03) | 0.724 | ||
Q3 | 75,087 | 7117 | 9.48 (9.26, 9.70) | 869,819.28 | 8.18 | 1.03 (0.99, 1.06) | 0.153 | 1.04 (1.00, 1.07) | 0.027 | ||
Q4 | 75,082 | 8638 | 11.50 (11.26, 11.75) | 853,918.79 | 10.12 | 1.07 (1.04, 1.11) | <0.001 | 1.10 (1.06, 1.13) | <0.001 | ||
VIM | <0.001 | <0.001 | |||||||||
Q1 | 75,081 | 6767 | 9.01 (8.80, 9.23) | 872,602.28 | 7.75 | 1 (reference) | 1 (reference) | ||||
Q2 | 75,082 | 6522 | 8.69 (8.48, 8.90) | 874,563.86 | 7.46 | 0.99 (0.95, 1.02) | 0.444 | 0.99 (0.96, 1.03) | 0.704 | ||
Q3 | 75,082 | 7117 | 9.48 (9.26, 9.70) | 869,749.16 | 8.18 | 1.03 (0.99, 1.06) | 0.156 | 1.04 (1.00, 1.07) | 0.027 | ||
Q4 | 75,081 | 8638 | 11.50 (11.26, 11.75) | 853,913.44 | 10.12 | 1.07 (1.04, 1.11) | <0.001 | 1.10 (1.06, 1.13) | <0.001 |
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Kim, D.; Kim, J.H.; Song, T.-J. Total Cholesterol Variability and the Risk of Osteoporotic Fractures: A Nationwide Population-Based Cohort Study. J. Pers. Med. 2023, 13, 509. https://doi.org/10.3390/jpm13030509
Kim D, Kim JH, Song T-J. Total Cholesterol Variability and the Risk of Osteoporotic Fractures: A Nationwide Population-Based Cohort Study. Journal of Personalized Medicine. 2023; 13(3):509. https://doi.org/10.3390/jpm13030509
Chicago/Turabian StyleKim, Dongyeop, Jee Hyun Kim, and Tae-Jin Song. 2023. "Total Cholesterol Variability and the Risk of Osteoporotic Fractures: A Nationwide Population-Based Cohort Study" Journal of Personalized Medicine 13, no. 3: 509. https://doi.org/10.3390/jpm13030509