Circulating sphingomyelins and mortality in a community-based Korean cohort: the Korean Genome and epidemiology study

Circulating sphingomyelins (SMs) have been proposed as biomarkers of mortality and cardiovascular risk, but findings have varied across populations. We aimed to evaluate the associations in a community-based Korean cohort. This cohort study included 2,434 participants from the Ansan–Ansung cohort of the Korean Genome and Epidemiology Study. Seven SM species were measured at the 2005–2006 examination, and mortality data were linked through December 2024. Associations with all-cause, cardiovascular, and non-cardiovascular mortality and the composite cardiovascular outcome were examined using Cox proportional hazards models adjusted for demographic, lifestyle, clinical and laboratory factors. Multiple testing was addressed using the Benjamini–Hochberg procedure across 28 tests within each adjustment model. During a median follow-up of 18.5 years, 426 deaths occurred, including 79 cardiovascular deaths. In the fully adjusted model, higher SM 16:0 levels were nominally associated with all-cause mortality (hazard ratio 1.70; 95% CI, 1.07–2.70; P = 0.025), but the association was not statistically significant after correction for multiple testing. None of the seven SM species were significantly associated with all-cause, cardiovascular, or non-cardiovascular mortality or with the composite cardiovascular outcome after correction for multiple testing. In this community-based Korean cohort, circulating SMs were not significantly associated with mortality or cardiovascular outcomes. This suggests that the prognostic relevance of circulating SMs may be limited and may vary according to population characteristics.