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<p>To explore the association between the Composite Dietary Antioxidant Index (CDAI) and all-cause, cardiovascular disease (CVD), and cancer mortality in U.S. adults with hyperlipidemia, and to assess the potential mediating role of inflammation-related biomarkers in this association. 25,383 patients with hyperlipidemia from the 2001–2018 National Health and Nutrition Examination Survey (NHANES) were included. The association between CDAI and mortality was assessed using weighted Cox regression models, Kaplan-Meier survival curves, subgroup analyses, and sensitivity analyses. Mediation analysis evaluated the roles of leucocytes, neutrophils, monocytes, lymphocytes, and the systemic inflammatory response index (SIRI). A total of 3,810 all-cause deaths, 1,218 CVD deaths, and 883 cancer deaths were recorded during the follow-up period. Fully adjusted models showed that highest CDAI (Q4 group) compared to the lowest quartile (Q1) was associated with a lower risk of all-cause (HR = 0.79, 95% CI: 0.68–0.91, <i>P</i> = 0.001), CVD (HR = 0.73, 95% CI: 0.55–0.96, <i>P</i> = 0.026) and cancer (HR = 0.72, 95% CI: 0.55–0.93, <i>P</i> = 0.011) mortality. The protective effect of vitamin E on the risk of death was most significant. The results of subgroup and sensitivity analyses were robust. Inflammatory indicators mediated the association between CDAI and mortality, with a range of changes from 1.11% to 4.12%. Higher CDAI, especially vitamin E intake, was independently associated with a significant reduction in all-cause, CVD, and cancer mortality in hyperlipidemic patients. Inflammation may partially mediate this association, with a modest mediation effect.</p>

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Composite dietary antioxidant index is inversely associated with all-cause, cardiovascular and cancer mortality in adults with hyperlipidemia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月14日

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  • Yingcong Liang,
  • Changhong Shi

摘要

To explore the association between the Composite Dietary Antioxidant Index (CDAI) and all-cause, cardiovascular disease (CVD), and cancer mortality in U.S. adults with hyperlipidemia, and to assess the potential mediating role of inflammation-related biomarkers in this association. 25,383 patients with hyperlipidemia from the 2001–2018 National Health and Nutrition Examination Survey (NHANES) were included. The association between CDAI and mortality was assessed using weighted Cox regression models, Kaplan-Meier survival curves, subgroup analyses, and sensitivity analyses. Mediation analysis evaluated the roles of leucocytes, neutrophils, monocytes, lymphocytes, and the systemic inflammatory response index (SIRI). A total of 3,810 all-cause deaths, 1,218 CVD deaths, and 883 cancer deaths were recorded during the follow-up period. Fully adjusted models showed that highest CDAI (Q4 group) compared to the lowest quartile (Q1) was associated with a lower risk of all-cause (HR = 0.79, 95% CI: 0.68–0.91, P = 0.001), CVD (HR = 0.73, 95% CI: 0.55–0.96, P = 0.026) and cancer (HR = 0.72, 95% CI: 0.55–0.93, P = 0.011) mortality. The protective effect of vitamin E on the risk of death was most significant. The results of subgroup and sensitivity analyses were robust. Inflammatory indicators mediated the association between CDAI and mortality, with a range of changes from 1.11% to 4.12%. Higher CDAI, especially vitamin E intake, was independently associated with a significant reduction in all-cause, CVD, and cancer mortality in hyperlipidemic patients. Inflammation may partially mediate this association, with a modest mediation effect.