Age-stratified optimal non-HDL cholesterol and all-cause mortality in a healthy Taiwanese population considering personal risk factors

BACKGROUND: Non-high-density lipoprotein cholesterol (non-HDL-C) is a key cardiovascular risk factor, yet its optimal range in healthy individuals remains unclear. METHODS: This study analyzed data from 134,343 adults aged 40-79 in the MJ Health Check-up Cohort in Taiwan (2000-2017). Participants with prior cardiovascular disease or extreme/incomplete BMI data (≥50 kg/m²) were excluded. Covariates included lifestyle, blood pressure, and diet. All-cause mortality was assessed using Cox proportional hazards models. RESULTS: The mean age was 51.8 years, and 47.3 % were male. Most participants (62.7 %) had a BMI of 18.5-25. The average non-HDL-C level was 146.8 mg/dL. A U-shaped association was observed between non-HDL-C levels and all-cause mortality. Compared with the reference group (160-179 mg/dL), non-HDL-C levels of <100, 100-119, 120-139, and ≥200 mg/dL were linked to elevated mortality risk, with hazard ratios (HR) of 1.42 (95 % CI: 1.31-1.54), 1.19 (1.11-1.27), 1.11 (1.04-1.18), and 1.11 (1.03-1.20), respectively. The highest risk was noted in the 40-49 age group with non-HDL-C ≥200 mg/dL, particularly among females (HR 1.72, 95 % CI: 1.15-2.58). However, no significant increase in risk was observed for the same category in older age groups. CONCLUSIONS: A non-HDL-C range of 160-179 mg/dL was associated with the lowest all-cause mortality among healthy Taiwanese adults. Both lower and higher levels were linked to increased mortality risk, highlighting the importance of maintaining moderate non-HDL-C levels to support longevity and overall health.