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Epidemiology

Association between high-density lipoprotein cholesterol level and risk of hematologic malignancy

Leukemia volume 35, pages 1356–1364 (2021)Cite this article

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Abstract

This study investigated the relationships between HDL-C and major types of blood cancers. Competing risks regression was used to examine the hazard ratios of hematologic malignancies in 9,596,145 individuals (≥20 years) using data from the Korean National Health Insurance Service (2009–2017). The incidence of the following hematologic cancers was determined based on the International Classification of Diseases 10th revision: Multiple Myeloma (MM), Hodgkin Lymphoma (HL), Non-Hodgkin Lymphoma (NHL), Lymphoid Leukemia (LL), and Myeloid Leukemia (ML). During an average of 8.3 years of follow-up (79,179,225 person-years), 15,864 incident hematologic malignancies were identified. Compared to those in the highest HDL-C quartile, subjects in the lowest HDL-C quartile had the highest risk of all hematologic cancers combined (adjusted hazard ratio [HR], 95% confidence interval [95% CI] = 1.31, 1.25–1.37) and of each respective type of blood cancer, as follows: MM (HR 1.61, 95% CI, 1.46–1.76), HL (HR 1.35, 95% CI 1.07–1.70), NHL (HR 1.12, 95%CI 1.04–1.21), LL (HR 1.36, 95% CI 1.16–1.61), and ML (HR 1.33, 95% CI 1.22–1.45). Low HDL-C level was significantly associated with increased risk of hematologic malignancy, suggesting that a low HDL-C level is an independent risk factor and preclinical marker for hematologic malignancy.

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Fig. 1: Cumulative incidence curves of hematologic cancer according to high-density lipoprotein cholesterol (HDL-C) levels.
Fig. 2: Association of high-density lipoprotein cholesterol (HDL-C) level and incidence of hematologic cancer in subgroups stratified by covariates.

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Acknowledgements

This study was performed using a database from the National Health Insurance System (NHIS).

Author information

Author notes

  1. These authors contributed equally: Su-Min Jeong, Taewoong Choi

Authors and Affiliations

  1. Department of Family Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea

    Su-Min Jeong

  2. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA

    Su-Min Jeong & Edward L. Giovannucci

  3. Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA

    Taewoong Choi

  4. Department of Medical Statistics, The Catholic University of Korea, Seoul, Republic of Korea

    Dahye Kim & Kyungdo Han

  5. Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center and Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Seok Jin Kim

  6. Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Republic of Korea

    Sang Youl Rhee

  7. Scripps Translational Science Institute, La Jolla, CA, USA

    Sang Youl Rhee

  8. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA

    Edward L. Giovannucci

  9. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, 02115, USA

    Edward L. Giovannucci

  10. Supportive Care Center/Department of Family Medicine, Samsung Medical Center, Seoul, Republic of Korea

    Dong Wook Shin

  11. Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea

    Dong Wook Shin

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Contributions

Conception and design: TC, KH, DWS. Acquisition of data: DK, KH. Analysis and interpretation of data: DK, KH, SMJ. Writing, review, and/or revision of the paper: SMJ, TC, SJK, SYR, ELG. Study supervision: DWS.

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Correspondence to Dong Wook Shin.

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Jeong, SM., Choi, T., Kim, D. et al. Association between high-density lipoprotein cholesterol level and risk of hematologic malignancy. Leukemia 35, 1356–1364 (2021). https://doi.org/10.1038/s41375-020-01081-5

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