Decrease in HDL-C is Associated with Age and Household Income in Adults from the Korean National Health and Nutrition Examination Survey 2017: Correlation Analysis of Low HDL-C and Poverty

A low serum high-density lipoproteins-cholesterol (HDL-C) level is a risk factor of cardiovascular disease and dementia. On the other hand, no study has elucidated the correlation between household income and the HDL-C level in the adult population. In the present study, 5535 subjects (20-80 year-old individuals) were selected from the Korean national health and nutrition examination survey 2017 (KNHANES VII-2, n = 2469 men, n = 3066 women). They were classified into five levels of household income grades ranging from one (the lowest) to five (the highest). They were also classified according to the HDL-C level: category 1 (<40 mg/dL, n = 943), category 2 (40-49 mg/dL, n = 1764), category 3 (50-59 mg/dL, n = 1572), category 4 (60-69 mg/dL, n = 820), and category 5 (>= 70 mg/dL, n = 436). Generally, in both genders, a higher HDL-C level is associated with a larger percentage of income grades 4 and 5. Moreover, the lowest HDL-C group showed the largest percentage of income grade 1. In both groups, a significant increase in the average income grade was associated with a concomitant increase in the HDL-C level (men, p = 0.03, women, p < 0.001). In the low HDL-C category, a lower income grade is associated directly with a lower HDL-C level, which suggests that poverty is associated directly with a low HDL-C. Women showed a 3.3-fold higher incidence of dementia than men did at later-life. The sharp decrease in HDL-C in the female group older than 50 was accompanied by a dramatic increase in the incidence of dementia. However, the male group showed a relatively mild decrease in the HDL-C level after mid-life and weak elevation in the incidence of dementia. In conclusion, in both genders, the lower income group showed a larger prevalence of low-HDL-C levels. The decrease in HDL-C after middle age was strongly associated with the considerable increase in dementia in later-life.