ArticleJournal of evaluation in clinical practice2012
Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study.
Article in Journal of evaluation in clinical practice, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Low-Density-Lipoprotein Cholesterol and Mortality Outcomes Among Healthy Older Adults: A Post Hoc Analysis of ASPREE Trial.The journals of gerontology. Series A, Biological sciences and medical sciences · 2024Trial
- Biological Effects of Hydrogen Water on Subjects with NAFLD: A Randomized, Placebo-Controlled Trial.Antioxidants (Basel, Switzerland) · 2022Article
- A nonlinear association of total cholesterol with all-cause and cause-specific mortality.Nutrition & metabolism · 2021Article
- Low Levels of Low-Density Lipoprotein Cholesterol and Endothelial Function in Subjects without Lipid-Lowering Therapy.Journal of clinical medicine · 2020Article
- Statin Treatment in Specific Patient Groups: Role for Improved Cardiovascular Risk Markers.Journal of clinical medicine · 2020Review
- Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults.Scientific reports · 2019Article
- The association between population density and blood lipid levels in Dutch blood donors.International journal of health geographics · 2019Article
- Mortality in persons with undetected and diagnosed hypertension, type 2 diabetes, and hypothyroidism, compared with persons without corresponding disease - a prospective cohort study; The HUNT Study, Norway.BMC family practice · 2017Article
- Algorithm for predicting CHD death risk in Turkish adults: conventional factors contribute only moderately in women.Anatolian journal of cardiology · 2017Article
- Prognostic factors of long-term survival in geriatric inpatients. Should we change the recommendations for the oldest people?The journal of nutrition, health & aging · 2015Article
- Age and gender differences in the prevalence and patterns of multimorbidity in the older population.BMC geriatrics · 2014Observational
- High LDL cholesterol and statin use were independently associated with lower eight-year mortality in a cohort free from terminal illness, cardiovascular disease, and diabetes at baseline.Scandinavian journal of primary health care · 2014Article
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5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
RATIONALE, AIMS AND
objectivesMany clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol is a frequently used variable in the risk estimates. Some studies indicate that the predictive properties of cholesterol might not be as straightforward as widely assumed. Our aim was to document the strength and validity of total cholesterol as a risk factor for mortality in a well-defined, general Norwegian population without known CVD at baseline.
methodsWe assessed the association of total serum cholesterol with total mortality, as well as mortality from CVD and ischaemic heart disease (IHD), using Cox proportional hazard models. The study population comprises 52 087 Norwegians, aged 20-74, who participated in the Nord-Trøndelag Health Study (HUNT 2, 1995-1997) and were followed-up on cause-specific mortality for 10 years (510 297 person-years in total).
resultsAmong women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95% confidence interval (CI): 0.89-0.99 per 1.0 mmol L(-1) increase] as well as CVD mortality (HR: 0.97; 95% CI: 0.88-1.07). The association with IHD mortality (HR: 1.07; 95% CI: 0.92-1.24) was not linear but seemed to follow a 'U-shaped' curve, with the highest mortality <5.0 and ≥7.0 mmol L(-1) . Among men, the association of cholesterol with mortality from CVD (HR: 1.06; 95% CI: 0.98-1.15) and in total (HR: 0.98; 95% CI: 0.93-1.03) followed a 'U-shaped' pattern.
conclusionOur study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the 'dangers' of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial.
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