10,443 incident cases were documented among 381,938 adults without COPD in the UK Biobank.
Nonlinear relationships were identified between serum lipid levels (HDL-C, LDL-C, TC, ApoA, ApoB) and the risk of COPD.
Abnormal levels of HDL-C and ApoA, as well as low levels of LDL-C, TC, and ApoB, are associated with an increased risk of COPD.
High or low levels of HDL-C and ApoA corresponded with an increased risk of COPD, with hazard ratios indicating a 15% to 16% higher risk in the lowest quintile.
Individuals in the lowest quintile of LDL-C, TC, and ApoB demonstrated over a 29% higher risk of COPD compared to those in the intermediate quintile.
Stratified analysis showed interactions between lipid levels, age, sex, and smoking status.
Simplified
OBJECTIVE: To investigate the relationship between serum lipid levels and the risk of (COPD) in the UK Biobank.
METHODS: We performed this prospective study in 381,938 adults without COPD from UK Biobank. Serum high-density cholesterol (HDL-C), low-density cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), apolipoprotein A (ApoA) and apolipoprotein B (ApoB) were measured and classified into quintiles. Restricted cubic spline (RCS) analysis was applied to visualize the dose-response relationship between lipids and COPD risk and Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).
RESULTS: We documented 10,443 incident COPD cases. Nonlinear relationships were found between HDL-C, LDL-C, TC, ApoA, ApoB and COPD risk with RCS analysis (P values for non-linearity < 0.05). Accordingly, multivariable-adjusted regression analysis indicated abnormal HDL-C and ApoA, and low LDL-C, TC and ApoB were associated with increased risk of COPD. Compared to intermediate quintile (Q3) group, both high or low HDL-C and ApoA were associated with risk of COPD. Corresponding HRs (95% CIs) were 1.15 (1.08-1.22), 1.16 (1.09-1.23) in Q1 group and 1.08 (1.01-1.16), 1.07 (1.00-1.14) in Q5 group. For LDL-C, TC and ApoB, there were more than 29% higher risk was observed in Q1 group with HRs (95% CIs) of 1.34 (1.27-1.42), 1.38 (1.30-1.46) and 1.29 (1.21-1.37), while HRs (95% CIs) were 0.88 (0.83-0.94), 0.92 (0.86-0.98) and 0.90 (0.84-0.95) in Q5 groups. We also observed the interactions between specific lipids and age at recruitment, sex and smoking status with stratified analysis.
CONCLUSIONS: Our study provides the first evidence demonstrating the associations between six major serum lipids and COPD risk, revealing multiple nonlinear relationships. There were U-shaped associations between serum HDL-C, ApoA and COPD risk, and L-shaped associations between LDL-C, TC, ApoB and COPD risk.
Key numbers
1.15
Increased Risk for Low HDL-C
Hazard Ratio for lowest HDL-C quintile compared to middle quintile
1.34
Increased Risk for Low LDL-C
Hazard Ratio for lowest LDL-C quintile compared to middle quintile
1.38
Increased Risk for Low Total Cholesterol
Hazard Ratio for lowest TC quintile compared to middle quintile
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Declarations. Ethics approval: This research was conducted according to the principles expressed in the Declaration of Helsinki. The UK Biobank study was approved by the North West Multi-Centre Research Ethics Committee (06/MRE08/65). Written informed consent was obtained from each participant. Participants gave informed consent to participate in the study before taking part. Competing interests: The authors declare no competing interests. Financial support: This study was supported by grants from Jiangsu Provincial Health Commission Medical Research Project (No.K2023072 and No.H2023022).
