What question did this study set out to answer?

To examine whether the reported U-shaped relationship between total cholesterol and coronary heart disease mortality is valid and to assess the impact of age and statin therapy on this association.

October 27, 2023Journal of the American Heart AssociationOpen Access

Serum Cholesterol and Impact of Age on Coronary Heart Disease Death in More Than 4 Million Veterans

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Why the study?

Recent reports of a U-shaped relation between cholesterol and death have challenged the lipid hypothesis, prompting investigation into whether this relationship is true and how age impacts it.

Is higher total cholesterol associated with increased coronary heart disease mortality in veterans?

Population

4 467 942 veterans aged >18 years in the Veterans Health Administration EHR system

Comparison

Different total cholesterol levels compared with 180 to 199 mg/dL

Design

Prospective cohort study

Follow-up

To December 30, 2018

Authors

XNXuan‐Mai T. NguyenUniversity of California, Los Angeles YHYuk‐Lam HoVA Boston Healthcare System YLYanping LiBGI Group (China)

Discussion

Member takes

Implication

Higher TC associated with CHD mortality in veterans; extends observational lipid hypothesis support but leaves causality open.

Key Points

To examine whether the reported U-shaped relationship between total cholesterol and coronary heart disease mortality is valid and to assess the impact of age and statin therapy on this association.
Conducted a prospective cohort study of 4,467,942 veterans aged >18 years with baseline outpatient visits from 2002 to 2007.
Followed participants through December 30, 2018, utilizing the Veterans Health Administration electronic health record system.
Evaluated multivariable-adjusted hazard ratios for coronary heart disease mortality across categories of total cholesterol with and without baseline statin use.
Observed a J-shaped relationship between total cholesterol and CHD mortality: risk was flat for total cholesterol <180 mg/dL and rose progressively at higher concentrations.
Compared with total cholesterol 180–199 mg/dL, multiadjusted HRs for CHD death were 1.03 (95% CI, 1.02–1.04) for 200–219 mg/dL, 1.07 (95% CI, 1.06–1.09) for 220–239 mg/dL, 1.15 (95% CI, 1.13–1.18) for 240–259 mg/dL, 1.25 (95% CI, 1.22–1.28) for 260–279 mg/dL, and 1.45 (95% CI, 1.42–1.49) for ≥280 mg/dL.
Identical J-shaped mortality patterns appeared among veterans with and without baseline statin therapy, confirming the lipid hypothesis across subgroups.

Structured PICO

Is higher total cholesterol associated with increased coronary heart disease mortality in veterans?

Population

4,467,942 veterans aged >18 years, with baseline outpatient visits from 2002 to 2007 in the Veterans Health Administration electronic health record system

Intervention

Higher total cholesterol levels (categories: 200-219, 220-239, 140-259, 260-279, and ≥280 mg/dL)

Comparator

Total cholesterol between 180 and 199 mg/dL

Outcome

Coronary heart disease (CHD) mortalityhard clinical

A J-shaped relationship exists between total cholesterol and CHD mortality, supporting the lipid hypothesis that lower cholesterol reduces CHD risk, with the 'cholesterol paradox' likely reflecting reverse causality in older patients.

Cite This Study

Nguyen et al. (2023) studied this question.

synapsesocial.com/papers/69dd44b2fb7610310c10171b https://doi.org/10.1161/jaha.123.030496

Topics

Statin therapy

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Serum Cholesterol and Impact of Age on Coronary Heart Disease Death in More Than 4 Million Veterans

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Serum Cholesterol and Impact of Age on Coronary Heart Disease Death in More Than 4 Million Veterans

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider