Low total cholesterol is associated with increased major adverse cardiovascular events in men aged ≥70 years not taking statins

Gnanenthiran, S.; Ng, A.; Cumming, Robert; Brieger, David; Couteur, David Le; Waite, Louise M.; Handelsman, David J.; Naganathan, Vasi; Kritharides, Leonard; Blyth, Fiona

doi:10.1136/heartjnl-2019-315449

Cited by 11 publications

(3 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As reported by Ravnskov et al, 7 there are many observations and experiments contradicting that high TC or LDL‐C causes atherosclerosis and CVD, and several recent observations have supported their view. For instance, six recent follow‐up studies including almost 700 000 individuals of all ages from various countries have shown that neither TC nor LDL‐C is a risk factor of mortality, neither among statin‐treated patients nor among untreated individuals 21‐25 . In fact, as shown by our results as well, low values are associated with increased total mortality.…”

Section: Discussionsupporting

confidence: 55%

Baseline plasma lipid levels in patients with acute coronary syndrome: Association with 20‐year mortality. The ABC‐5a* Study on Heart Disease

Berton

Cordiano²,

Mahmoud

et al. 2020

Int J Clin Pract

View full text Add to dashboard Cite

Background The relationship between baseline plasma lipid levels during acute coronary syndrome and the outcome has clinical relevance. Methods To evaluate their long‐term prognostic value, we examined 589 patients admitted with acute coronary syndrome at three hospitals. Baseline plasma lipids were assessed on days 1 and 7. Patients were followed for 20 years or until death. Results Virtually, all patients completed follow‐up; 437 (74%) had died: 24% from coronary artery disease/heart failure (CAD/HF), 21% sudden cardiac death (SCD), 16% from other cardiovascular causes and 39% had non‐cardiac death. The incidence rate (IR) of all‐cause mortality was not different among patients with baseline plasma lipids less or greater than the median value. The IR of CAD/HF mortality was not significantly higher among patients with greater than median low‐density lipoprotein (LDL) cholesterol and triglyceride (TG) levels. The IR of non‐cardiac death tended to be lower among patients with greater than median total cholesterol (TC) and LDL levels. Using three levels of adjusted Cox survival models, baseline plasma lipids had no consistent independent or inverse association with all‐cause mortality, even after excluding patients who received statins. Competitive risk survival models for each cause of death revealed that the only hazard of non‐cardiac death was consistently higher among patients with less than or equal to median TC and LDL levels. Conclusion In the present prospective long‐term study, after acute coronary syndrome, baseline plasma lipid levels seem not to be associated with long‐term global mortality. Only an independent inverse association between TC and LDL and non‐cardiac death has been observed.

show abstract

Section: Discussionsupporting

confidence: 55%

Baseline plasma lipid levels in patients with acute coronary syndrome: Association with 20‐year mortality. The ABC‐5a* Study on Heart Disease

Berton

Cordiano²,

Mahmoud

et al. 2020

Int J Clin Pract

View full text Add to dashboard Cite

show abstract

“…However, for CVD mortality, aged people (age ≥ 65 years) with TC range < 120 mg/dL had a higher risk of death, and those below 65 years of age with TC range ≥ 280 mg/dL were more likely to die relative to aged people. Similarly, the association between low TC and higher occurrence rate of serious adverse cardiovascular events in men aged ≥ 70 years has also been reported [24].…”

Section: Discussionmentioning

confidence: 69%

A dose-dependent association of total cholesterol with all-cause and specific mortality: results from the National Health and Nutrition Examination Survey

He¹,

Liu²,

Liu³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The link between total cholesterol (TC) and all-cause and specific mortality has not been elucidated. Herein, we aimed to evaluate the effect of TC levels on all-cause, cardiovascular disease (CVD), and cancer mortality.Methods: All data analyzed were obtained from the National Health and Nutrition Examination Survey 1999-2014. The relationship between levels of TC and mortality was determined through Cox proportional hazard regression analysis coupled with multivariable adjustments. Two-piecewise linear regression model and Cox models with penalized splines were applied to explore non-linear and irregular shape relationships. Kaplan-Meier survival curve and subgroup analyses were conducted.Results: The sample studied comprised 17853 men and 18922 women, categorized as 27927 adults aged 18–65 years and 8848 adults more than 65 years old. A total of 4441 deaths were recorded. All-cause, cardiovascular, and cancer mortality showed U-curve associations with nadir at 213 mg/dL, 200 mg/dL, and 218mg/dL after adjusting for confounding variables in the restricted cubic spline analysis. HRs of all-cause, CVD, and cancer mortality was particularly negatively related to TC levels in the lower range <200 mg/dL, especially in the range <120 mg/dL (HR 1.95; 95% CI 1.59, 2.38, HR 1.78; 95% CI 1.16, 2.72, HR 2.18; 95% CI 1.46, 3.25, respectively). The lowest cumulative survival rate was recorded in the lowest TC level group.Conclusions: A U-curve association of TC level with all-cause, cancer, and CVD mortality in the American population was observed, suggesting that too low or too high serum total cholesterol levels might correlate with adverse outcomes.

show abstract

“…For CVD mortality, individuals aged below 65 years with a TC range of ≥ 280 mg/ dL were more likely to die compared to aged 65 years or older. However, the association between low TC and a higher occurrence rate of serious adverse cardiovascular events in men aged ≥ 70 years has also been reported [26]. TC levels were usually classified into three categories: desirable (less than 200), borderline high (between 200 and 239), and high level (≥ 240 mg/dL).…”

Section: Discussionmentioning

confidence: 99%

A nonlinear association of total cholesterol with all-cause and cause-specific mortality

Liu

et al. 2021

Nutr Metab (Lond)

View full text Add to dashboard Cite

Background The link between total cholesterol (TC) and all-cause and specific mortality has not been elucidated. Herein, we aimed to evaluate the effect of TC levels on all-cause, cardiovascular disease (CVD), and cancer mortality. Methods All data analyzed were obtained from the National Health and Nutrition Examination Survey 1999–2014. The relationship between levels of TC and mortality was determined through Cox proportional hazard regression analysis coupled with multivariable adjustments. Two-piecewise linear regression models and Cox models with penalized splines were applied to explore nonlinear and irregular shape relationships. Kaplan–Meier survival curve and subgroup analyses were conducted. Results The sample studied comprised 14,662 men and 16,025 women, categorized as 25,429 adults aged 18–65 and 5,258 adults over 65 years old. A total of 2,570 deaths were recorded. All-cause, cardiovascular, and cancer mortality showed U-curve associations after adjusting for confounding variables in the restricted cubic spline analysis. Hazard ratios (HRs) of all-cause and cancer mortality were particularly negatively related to TC levels in the lower range < 200 mg/dL, especially in the range < 120 mg/dL (HR 1.97; 95% CI 1.38, 2.83, HR 2.39; 95% CI 1.21, 4.71, respectively). However, the HRs of cardiovascular disease mortality in the range < 120 mg/dL were the lowest (HR 0.60; 95% CI 0.15, 2.42). In the upper range, a TC range of ≥ 280 mg/dL was correlated with mortality as a result of CVD and cancer (HR 1.31; 95% CI 0.87, 1.97 and HR 1.22; 95% CI 0.82, 1.79). The lowest cumulative survival rate of all-cause mortality was recorded in the lowest TC-level group, while the lowest cumulative survival rate of CVD mortality was recorded in the highest TC-level group. Conclusions A nonlinear association of TC level with all-cause, cancer, and CVD mortality in the American population was observed, suggesting that too low or too high serum total cholesterol levels might correlate with adverse outcomes.

show abstract

Low total cholesterol is associated with increased major adverse cardiovascular events in men aged ≥70 years not taking statins

Cited by 11 publications

References 33 publications

Baseline plasma lipid levels in patients with acute coronary syndrome: Association with 20‐year mortality. The ABC‐5a* Study on Heart Disease

Baseline plasma lipid levels in patients with acute coronary syndrome: Association with 20‐year mortality. The ABC‐5a* Study on Heart Disease

A dose-dependent association of total cholesterol with all-cause and specific mortality: results from the National Health and Nutrition Examination Survey

A nonlinear association of total cholesterol with all-cause and cause-specific mortality

Contact Info

Product

Resources

About