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Background <p>Low-density lipoprotein cholesterol (LDL-C) and inflammation are two main factors contributing to risk of cardiovascular disease (CVD) mortality. However, their joint associations remain controversial, and it is unknown whether physical activity (PA) can modify these associations.</p> Methods <p>A total of 18,416 US adults with a total of 150047.8 person-years follow-up from the National Health and Nutrition Examination Survey (NHANES) including general population, patients with atherosclerotic cardiovascular disease (ASCVD), and individuals at extreme risk, and 2575 Chinese adults with a total of 10736.8 person-years follow-up from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) including general population and patients with non-communicable diseases (NCDs) were analyzed. Restricted cubic spline, Cox regression models, and mediation analyses were employed to estimate associations between PA, LDL-C, systemic immune-inflammation index (SII) in the NHANES/platelet-to-lymphocyte ratio (PLR) in the CLHLS, and the risk of mortality from all-cause and CVD.</p> Results <p>The combined effects were significant, which included LDL-C with SII on mortality from all-cause and CVD among the general population and ASCVD patients in the NHANES, and LDL-C with PLR on all-cause mortality among NCDs patients in the CLHLS. Compared with participants with LDL-C in tertile 2 (T2) and SII/PLR in T2, the hazard ratios (HRs) and 95% confidence intervals (95%CIs) for all-cause/CVD mortality in participants with LDL-C in T1/T3 and SII/PLR in T1/T3 were 1.47 (1.23–1.76)/1.36 (1.01–1.84), 1.40 (1.06–1.86)/1.67 (1.01–2.75) in the NHANES, and 1.22 (0.96–1.55) for all-cause mortality in the CLHLS, respectively. PA significantly reduced the above-mentioned risks: compared with participants who did not engage in PA, the HRs (95%CIs) for those who engaged in PA were 0.56 (0.48–0.67)/0.54 (0.41–0.71), 0.62 (0.45–0.86)/0.78 (0.50–1.20) in the NHANES, and 0.67 (0.51–0.87) for all-cause mortality in the CLHLS, respectively. LDL-C and inflammation mediated 4.99%–20.01% of the association between PA and mortality from all-cause/CVD.</p> Conclusions <p>Either low LDL-C level or high inflammation level was associated with increased risk of mortality from all-cause and CVD. Engagement in PA can reduce the above mortality risks related to abnormal levels of LDL-C and inflammation, providing practical implications for public health interventions.</p> Graphical Abstract <p></p>

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Joint association of LDL cholesterol and inflammation with mortality and the modifying effect of physical activity: findings from two population-based cohort studies

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月1日

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  • Chunxin Wu,
  • Linsen Chen,
  • Lei Luo,
  • Meng Sun,
  • Shengqiang Huang,
  • Wei Shao,
  • Xiaoyan Wu

摘要

Background

Low-density lipoprotein cholesterol (LDL-C) and inflammation are two main factors contributing to risk of cardiovascular disease (CVD) mortality. However, their joint associations remain controversial, and it is unknown whether physical activity (PA) can modify these associations.

Methods

A total of 18,416 US adults with a total of 150047.8 person-years follow-up from the National Health and Nutrition Examination Survey (NHANES) including general population, patients with atherosclerotic cardiovascular disease (ASCVD), and individuals at extreme risk, and 2575 Chinese adults with a total of 10736.8 person-years follow-up from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) including general population and patients with non-communicable diseases (NCDs) were analyzed. Restricted cubic spline, Cox regression models, and mediation analyses were employed to estimate associations between PA, LDL-C, systemic immune-inflammation index (SII) in the NHANES/platelet-to-lymphocyte ratio (PLR) in the CLHLS, and the risk of mortality from all-cause and CVD.

Results

The combined effects were significant, which included LDL-C with SII on mortality from all-cause and CVD among the general population and ASCVD patients in the NHANES, and LDL-C with PLR on all-cause mortality among NCDs patients in the CLHLS. Compared with participants with LDL-C in tertile 2 (T2) and SII/PLR in T2, the hazard ratios (HRs) and 95% confidence intervals (95%CIs) for all-cause/CVD mortality in participants with LDL-C in T1/T3 and SII/PLR in T1/T3 were 1.47 (1.23–1.76)/1.36 (1.01–1.84), 1.40 (1.06–1.86)/1.67 (1.01–2.75) in the NHANES, and 1.22 (0.96–1.55) for all-cause mortality in the CLHLS, respectively. PA significantly reduced the above-mentioned risks: compared with participants who did not engage in PA, the HRs (95%CIs) for those who engaged in PA were 0.56 (0.48–0.67)/0.54 (0.41–0.71), 0.62 (0.45–0.86)/0.78 (0.50–1.20) in the NHANES, and 0.67 (0.51–0.87) for all-cause mortality in the CLHLS, respectively. LDL-C and inflammation mediated 4.99%–20.01% of the association between PA and mortality from all-cause/CVD.

Conclusions

Either low LDL-C level or high inflammation level was associated with increased risk of mortality from all-cause and CVD. Engagement in PA can reduce the above mortality risks related to abnormal levels of LDL-C and inflammation, providing practical implications for public health interventions.

Graphical Abstract