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March 09, 2021; 96 (10) Article

Association of High-Density Lipoprotein Cholesterol Variability and the Risk of Developing Parkinson Disease

Joo-Hyun Park, Chung-woo Lee, Myung Ji Nam, Hyunjin Kim, Do-Young Kwon, Ji Won Yoo, Kyu Na Lee, Kyungdo Han, Jin-Hyung Jung, Yong-Gyu Park, Do-Hoon Kim
First published February 3, 2021, DOI: https://doi.org/10.1212/WNL.0000000000011553
Joo-Hyun Park
From the Departments of Family Medicine (J.-H.P., C.-w.L., M.J.N., H.K., D.-H.K.) and Neurology (D.-Y.K.), Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea; Department of Internal Medicine (J.W.Y.), University of Nevada Las Vegas School of Medicine; Department of Statistics and Actuarial Science (K.N.L., K.H.), Soongsil University; and Department of Biostatistics (J.-H.J., Y.-G.P.), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Chung-woo Lee
From the Departments of Family Medicine (J.-H.P., C.-w.L., M.J.N., H.K., D.-H.K.) and Neurology (D.-Y.K.), Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea; Department of Internal Medicine (J.W.Y.), University of Nevada Las Vegas School of Medicine; Department of Statistics and Actuarial Science (K.N.L., K.H.), Soongsil University; and Department of Biostatistics (J.-H.J., Y.-G.P.), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Myung Ji Nam
From the Departments of Family Medicine (J.-H.P., C.-w.L., M.J.N., H.K., D.-H.K.) and Neurology (D.-Y.K.), Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea; Department of Internal Medicine (J.W.Y.), University of Nevada Las Vegas School of Medicine; Department of Statistics and Actuarial Science (K.N.L., K.H.), Soongsil University; and Department of Biostatistics (J.-H.J., Y.-G.P.), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Hyunjin Kim
From the Departments of Family Medicine (J.-H.P., C.-w.L., M.J.N., H.K., D.-H.K.) and Neurology (D.-Y.K.), Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea; Department of Internal Medicine (J.W.Y.), University of Nevada Las Vegas School of Medicine; Department of Statistics and Actuarial Science (K.N.L., K.H.), Soongsil University; and Department of Biostatistics (J.-H.J., Y.-G.P.), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Do-Young Kwon
From the Departments of Family Medicine (J.-H.P., C.-w.L., M.J.N., H.K., D.-H.K.) and Neurology (D.-Y.K.), Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea; Department of Internal Medicine (J.W.Y.), University of Nevada Las Vegas School of Medicine; Department of Statistics and Actuarial Science (K.N.L., K.H.), Soongsil University; and Department of Biostatistics (J.-H.J., Y.-G.P.), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Ji Won Yoo
From the Departments of Family Medicine (J.-H.P., C.-w.L., M.J.N., H.K., D.-H.K.) and Neurology (D.-Y.K.), Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea; Department of Internal Medicine (J.W.Y.), University of Nevada Las Vegas School of Medicine; Department of Statistics and Actuarial Science (K.N.L., K.H.), Soongsil University; and Department of Biostatistics (J.-H.J., Y.-G.P.), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Kyu Na Lee
From the Departments of Family Medicine (J.-H.P., C.-w.L., M.J.N., H.K., D.-H.K.) and Neurology (D.-Y.K.), Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea; Department of Internal Medicine (J.W.Y.), University of Nevada Las Vegas School of Medicine; Department of Statistics and Actuarial Science (K.N.L., K.H.), Soongsil University; and Department of Biostatistics (J.-H.J., Y.-G.P.), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Kyungdo Han
From the Departments of Family Medicine (J.-H.P., C.-w.L., M.J.N., H.K., D.-H.K.) and Neurology (D.-Y.K.), Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea; Department of Internal Medicine (J.W.Y.), University of Nevada Las Vegas School of Medicine; Department of Statistics and Actuarial Science (K.N.L., K.H.), Soongsil University; and Department of Biostatistics (J.-H.J., Y.-G.P.), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Jin-Hyung Jung
From the Departments of Family Medicine (J.-H.P., C.-w.L., M.J.N., H.K., D.-H.K.) and Neurology (D.-Y.K.), Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea; Department of Internal Medicine (J.W.Y.), University of Nevada Las Vegas School of Medicine; Department of Statistics and Actuarial Science (K.N.L., K.H.), Soongsil University; and Department of Biostatistics (J.-H.J., Y.-G.P.), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Yong-Gyu Park
From the Departments of Family Medicine (J.-H.P., C.-w.L., M.J.N., H.K., D.-H.K.) and Neurology (D.-Y.K.), Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea; Department of Internal Medicine (J.W.Y.), University of Nevada Las Vegas School of Medicine; Department of Statistics and Actuarial Science (K.N.L., K.H.), Soongsil University; and Department of Biostatistics (J.-H.J., Y.-G.P.), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Do-Hoon Kim
From the Departments of Family Medicine (J.-H.P., C.-w.L., M.J.N., H.K., D.-H.K.) and Neurology (D.-Y.K.), Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea; Department of Internal Medicine (J.W.Y.), University of Nevada Las Vegas School of Medicine; Department of Statistics and Actuarial Science (K.N.L., K.H.), Soongsil University; and Department of Biostatistics (J.-H.J., Y.-G.P.), College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Citation
Association of High-Density Lipoprotein Cholesterol Variability and the Risk of Developing Parkinson Disease
Joo-Hyun Park, Chung-woo Lee, Myung Ji Nam, Hyunjin Kim, Do-Young Kwon, Ji Won Yoo, Kyu Na Lee, Kyungdo Han, Jin-Hyung Jung, Yong-Gyu Park, Do-Hoon Kim
Neurology Mar 2021, 96 (10) e1391-e1401; DOI: 10.1212/WNL.0000000000011553

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Abstract

Objective To investigate the longitudinal association among high-density lipoprotein cholesterol (HDL-C) level, HDL-C variability, and the risk of developing Parkinson disease (PD).

Methods We conducted a nationwide, population-based cohort study. We included 382,391 patients aged ≥65 years who underwent at least 3 health examinations provided by the Korean National Health Insurance System from 2008 to 2013 and followed up until 2017. Individuals with a history of PD and missing values were excluded (n = 1,987). We assessed HDL-C variability using 3 indices, including variability independent of the mean (VIM). A multivariate-adjusted Cox proportional hazards regression analysis was performed.

Results Among the 380,404 participants, 2,733 individuals were newly diagnosed with PD during a median follow-up period of 5 years. The lowest quartile (Q1) group of baseline HDL-C and mean HDL-C was associated with increased PD incidence as compared with the highest quartile (Q4) group (adjusted hazard ratio [aHR], 1.20; 95% confidence interval [CI], 1.08–1.34; and aHR, 1.16; 95% CI, 1.04–1.30, respectively). The Q4 group of HDL-C variability (VIM) was associated with increased PD incidence compared to the Q1 group (aHR, 1.19; 95% CI, 1.06–1.33). The group with the Q1 of baseline HDL-C and with the Q4 of HDL-C variability had the highest risk of PD incidence (aHR, 1.6; 95% CI, 1.31–1.96).

Conclusion Lower HDL-C level and greater HDL-C variability were associated with a higher incidence of PD.

Glossary

BMI=
body mass index;
BP=
blood pressure;
CETP=
cholesteryl ester transfer protein;
CI=
confidence interval;
CKD=
chronic kidney disease;
CV=
coefficient of variation;
HDL-C=
high-density lipoprotein cholesterol;
HR=
hazard ratio;
ICD-10-CM=
International Classification of Diseases, 10th revision, Clinical Modification;
IRB=
institutional review board;
NHIS=
National Health Insurance Service;
PD=
Parkinson disease;
RID=
rare intractable disease;
VIM=
variability independent of the mean

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • ↵* These authors contributed equally to this work.

  • Editorial, page 465

  • Received April 30, 2020.
  • Accepted in final form November 9, 2020.
  • © 2021 American Academy of Neurology
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