Impact of lipid profiles and risk factors on all-cause mortality in males and females: insights from a Turkish cohort study.

Objectives: This study examined associations between lipid profiles, anthropometric measures, and all-cause mortality in a Turkish adult cohort, stratified by sex. Methods: This prospective study analyzed 2,378 participants from the TEKHARF cohort over a median follow-up of 256 months (up to 25 years). All-cause mortality was evaluated using sex-specific Cox proportional hazards regression models and Restricted Cubic Spline analysis to assess non-linear associations with baseline lipid parameters, anthropometric measures, and clinical risk factors. Results: During follow-up, 811 deaths (34.1 %) occurred, with significantly higher mortality in males vs. females (37.5 vs. 30.6 %, p<0.001). Low income, physical inactivity, hypertension, and diabetes were strongly associated with mortality in both sexes. In multivariate models, age, hypertension, and diabetes emerged as the most robust independent predictors of mortality. Although total cholesterol and LDL-C quartiles showed associations with mortality in unadjusted analyses, these became non-significant after adjustment. In males, HDL-C in the third quartile (Q3) was associated with a lower risk of mortality compared to the lowest quartile (HR: 0.759, p=0.045), whereas the highest triglyceride quartile independently predicted mortality only in males (HR: 1.464, p=0.008). Conclusions: Traditional cardiometabolic risk factors, particularly age, hypertension, and diabetes, were the dominant mortality determinants. Notably, in males, triglycerides demonstrated a sex-specific independent effect on mortality risk, while intermediate HDL-C levels were associated with reduced mortality, emphasizing the importance of comprehensive risk assessment integrating lipid parameters with established clinical factors.