Redefining the association of triglycerides with all-cause and Cardiovascular Disease Mortality in the Chinese population: a nationwide, population-based, prospective cohort study of 3.8 million Chinese adults

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Background: Current international guidelines on dyslipidemia were formulated based on the research performed mostly in White populations. However, whether the association of triglycerides (TGs) with cardiovascular disease (CVD) differs between Chinese and White populations is unknown. Methods: 3,789,025 participants from the China Health Evaluation And risk Reduction through nationwide Teamwork (ChinaHEART) were evaluated for the association between TGs and all-cause and CVD mortality with Cox regression models. The findings were tested for sex-specific differences and contrasted with another comparison cohort of 434,919 UK Biobank participants. Findings: 92,888 Chinese adults died during a median follow-up of 4.6 years. All-cause and CVD mortality initially increased with TG elevation abruptly and plateaued in Chinese men, while U-shaped associations were seen in Chinese women. In contrast, CVD risk increased incrementally with TGs in White people. Hazard ratios (95% confidence intervals) were 1.02 (0.97-1.07), 1.05 (1.00-1.11), 1.07 (1.02-1.22), and 1.19 (1.13-1.24) from TG quintile 2 to 5 for White men, and 1.14 (1.08-1.21), 1.17 (1.11-1.24), 1.26 (1.18-1.33), and 1.41 (1.33-1.50) for White women, respectively. The association with CVD mortality was stronger in Chinese men who were lean, normotensive, and smoking but in Chinese women with diabetes. Interpretation: The association of TGs with CVD was different for the White and the Chinese populations. That mortality risk elevated in conventionally low-to-moderate TG range implicates that more aggressive intervention may be merited for Chinese and other East Asian populations. Funding: The National High Level Hospital Clinical Research Funding (2023-GSP-ZD-2, 2023-GSP-RC-01), the Ministry of Finance, and the National Health Commission of China.

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