Association between HDL-C variability and the risk of chronic obstructive pulmonary disease in the middle- and older Chinese: a cohort study

Chronic obstructive pulmonary disease (COPD) is a significant public health issue, especially among middle-aged and older populations. Although variability in high-density lipoprotein cholesterol (HDL-C) have been linked to various health outcomes, their relationship with COPD remains insufficiently understood. This study aims to evaluate the association between HDL-C variability and COPD risk in a Chinese cohort using a retrospective design. A total of 5,610 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included, each of whom had undergone at least two consecutive health assessments in the 2011 and 2015. HDL-C variability was assessed using three indicators: (1) variability independent of the mean (VIM), (2) average real variability (ARV), and (3) the standard deviation (SD) of HDL-C levels from baseline to follow-up. COPD status was determined through a questionnaire in 2018. Logistic regression models were applied to examine the association between HDL-C variability and COPD risk, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Among CHARLS participants (mean age 58.72 ± 8.52 years; 44.71% male), higher HDL-C variability was associated with increased COPD risk. The highest quartile of ARV showed a significant association compared with the lowest quartile [OR 1.30, 95% CI 1.07–1.57; P = 0.01; P for trend = 0.02], and each one standard deviation increase in ARV corresponded to an OR of 1.11 (95% CI 1.03–1.18, P < 0.01), indicating a dose–response relationship. Results for SD were similar, whereas VIM was significant only as a continuous variable. Higher visit-to-visit HDL-C variability independently increased COPD risk in middle-aged and older Chinese adults. HDL-C variability represents a novel risk marker beyond static lipid levels. Stabilizing HDL-C could offer a potential preventive strategy, warranting further mechanistic and interventional studies.