Is a high serum cholesterol level associated with longer survival in elderly hypertensives?

Staessen, Jan A.; Améry, A; Wh, Birkenhäger; Bulpitt, Christopher J.; Clément, Denis; P, De Leeuw; Deruyttere, M; A, De Schaepdryver; Dollery, C. T.; Fagard, Robert; Fletcher, Astrid; Forette, Françoise; Forte, J; Henry, John-Fran??ois; Koistinen, A; Leonetti, Gastone; Nissinen, Anne; Pelemans, Walter; Jc, Petrie; Tk, Strasser; Terzoli, L.; Thijs, Lutgarde; Tuomilehto, J; Webster, J; Bo, Williams; Investigators, Syst-Eur; Sarti, Cinzia

doi:10.1097/00004872-199008000-00010

Cited by 46 publications

(32 citation statements)

References 19 publications

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“…Cardiovascular mortality was not enhanced by hypercholesterolaemia; as in other studies, 52,63,64 lower cholesterol levels were even associated with shorter, rather than longer, overall survival ( Figure 1). Once more, inappropriate nutrition could be an explanation for this finding.…”

Section: Discussionsupporting

confidence: 77%

Weak effect of hypertension and other classic risk factors in the elderly who have already paid their toll

et al. 2002

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The aim of the CASTEL, a population-based (n ‫؍‬ 3282) prospective study which began 14 years ago, was to identify those items which had a prognostic impact in the elderly, and to evaluate whether the typical cardiovascular risk factors, particularly arterial hypertension, play a role after the age of 65 years. Initial screening, final follow-up and annual detection of mortality were performed. Mantel-Hanszel approach and multivariate Cox model were used for statistics. Cardiovascular mortality was 23.3% in normotensive, 23.3% in borderline, and 25% in the sustained hypertensive subjects (insignificant difference). In women, the incidence of stroke and coronary artery disease weakly depended on pulse pressure. Historical stroke and myocardial infarction predicted cardiovascular mortality in women; diabetes, uricaemia and high heart rate in men. In the very old, the predictors were less numerous, and blood pressure was not a predictor whatsoever; pulse blood

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Section: Discussionsupporting

confidence: 77%

Weak effect of hypertension and other classic risk factors in the elderly who have already paid their toll

et al. 2002

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“…However, in studies in the elderly, total serum cholesterol is often not positively associated with cardiovascular and noncardiovascular mortality [18]. In Asian populations, the association between serum total cholesterol and stroke is weak [24] and there is even a tendency of an inverse correlation with haemorrhagic stroke [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…Means and proportions were contrasted by the t-test and the chi-squared statistic, respectively. The incidence rates by smoking status at entry were calculated with standardization for sex and age by the direct method [18]. We used multiple Cox regression to study the association between outcome and predictors [19].…”

Section: Methodsmentioning

confidence: 99%

Risks of smoking in treated and untreated older Chinese patients with isolated systolic hypertension

Wang

Staessen

Fagard

et al. 2001

Journal of Hypertension

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Objectives To examine the health risks associated with smoking and blood pressure in Chinese hypertensive patients and to compare the bene®t of antihypertensive drug treatment with the risk attributable to smoking.Methods We used multiple Cox regression to correlate outcome with blood pressure and smoking status in 2284 older (aged > 60 years) patients enrolled in the Systolic Hypertension in China (Syst-China) Trial (systolic/diastolic blood pressure > 160/< 95 mmHg).Results Median follow-up was 3.0 years. After adjustment for sex, age, active antihypertensive treatment and various entry characteristics, the relative hazard rates associated with smoking more than 20 cigarettes per day were 2.04 (P = 0.04), 4.66 (P < 0.001) and 4.74 (P = 0.002) for allcause, noncardiovascular and cancer mortality, respectively. With similar adjustments applied, the relative hazard rates for total (fatal and non-fatal) stroke associated with smoking 10±20 and more than 20 cigarettes per day were 1.78 (P = 0.04) and 2.23 (P = 0.03), respectively. Furthermore, both smoking and systolic blood pressure were associated with higher risk of stroke. Compared with the overall risk in the whole group, treating 1000 patients for 5 years prevented 40 [95% con®dence interval (CI), 5±75] strokes in smokers as well as never smokers. Prognosis in never smokers and past smokers was similar. Quitting smoking had the potential to prevent 51 (95% CI, 221 to 122) strokes in untreated hypertensive patients and to prevent 45 (95% CI, ±14 to 104) additional strokes in treated patients, over and above the effects of antihypertensive treatment. If, in addition to stroke, noncardiovascular mortality was also accounted for, the estimated absolute bene®t of quitting smoking increased to 69 (95% CI, 218 to 155) and 97 (95% CI, 23±171) events in the untreated and the treated group, respectively.Conclusions In elderly Chinese patients, smoking was a risk factor for all-cause, non-cardiovascular and cancer mortality, as well as fatal and non-fatal stroke. The potential bene®ts of antihypertensive treatment and quitting smoking were approximately similar. In our view, these ®ndings are important in terms of public health policies and health economics.

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“…Incidence rates in quartiles of the distributions of serum creatinine and uric acid were calculated with adjustments made for gender and age by use of the direct method. 25 Relative hazard rates and 95% CIs were estimated by single and multiple Cox regressions. 26 The statistical methods also included single and multiple linear regressions.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Significance of Serum Creatinine and Uric Acid in Older Chinese Patients With Isolated Systolic Hypertension

et al. 2001

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Abstract-We examined the relation of serum creatinine and uric acid to mortality and cardiovascular disease in older (aged Ն60 years) Chinese patients with isolated systolic hypertension (systolic/diastolic blood pressure Ն160/ Ͻ95 mm Hg). We used Cox regression to correlate outcome with baseline serum creatinine and uric acid measured in 1880 and 1873, respectively, of the 2394 patients enrolled in the placebo-controlled Systolic Hypertension in China (Syst-China) Trial. Median follow-up was 3 years. In multiple Cox regression analysis with adjustment for gender, age, active treatment, and other significant covariates, serum creatinine was significantly associated with a worse prognosis. The relative hazard rates (95% CIs) associated with a 20-mol/L increase in serum creatinine for all-cause, cardiovascular, and stroke mortality were 1.16 (1.05 to 1.27, Pϭ0.003), 1.15 (1.01 to 1.31, Pϭ0.03), and 1.37 (1.13 to 1.65, Pϭ0.001), respectively. In a similar analysis, which also accounted for serum creatinine, serum uric acid was also significantly and independently associated with excess mortality of cardiovascular disease and stroke. The relative hazard rates associated with a 50-mol/L increase of serum uric acid were 1.14 (1.02 to 1.27, Pϭ0.02) for cardiovascular mortality and 1.34 (1.14 to 1.57, PϽ0.001) for fatal stroke. In conclusion, in older Chinese patients with isolated systolic hypertension, serum creatinine and serum uric acid were predictors of mortality. (Hypertension. 2001; 37:1069-1074.)

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Is a high serum cholesterol level associated with longer survival in elderly hypertensives?

Cited by 46 publications

References 19 publications

Weak effect of hypertension and other classic risk factors in the elderly who have already paid their toll

Weak effect of hypertension and other classic risk factors in the elderly who have already paid their toll

Risks of smoking in treated and untreated older Chinese patients with isolated systolic hypertension

Prognostic Significance of Serum Creatinine and Uric Acid in Older Chinese Patients With Isolated Systolic Hypertension

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