Abstract 16619: Relationship Between Serum Cholesterol and Risk of Premature Death From Coronary Heart Disease in Male Veterans: is it Still Continuous and Graded?
Introduction: The MRFIT Screenees project, conducted before the widespread use of statins, showed that greater serum cholesterol levels were associated with an increased risk of coronary heart disease (CHD) death. We examined outpatient serum cholesterol levels and 6 year CHD death in male Veterans in the VA Healthcare system between 2002-2007.
Methods: Analyses were restricted to subjects free of cancer, not on statins, and without a history of a myocardial infarction at baseline. Cox models were used to estimate hazard ratios (HR) for CHD death. CHD death was defined using I20-I25 ICD-10 codes from the National Death Index.
Results: Among 1,261,762 subjects we observed a J-shaped relationship between cholesterol categories and age-adjusted hazard ratios for White and Black males (Table 1). CHD death was more than doubled in the highest cholesterol group for both Whites (HR: 2.15) and Blacks (HR: 2.43) compared to the second group. After multivariable adjustment for age, diabetes, major mental health diagnosis, systolic blood pressure (SBP) and smoking status, we found that the HR for CHD death among the low cholesterol group was attenuated, suggesting that some of the increased mortality observed was explained by comorbidities. In the same model, the effect of SBP on CHD death was also noteworthy: 5% increase risk of CHD death for SBP>140 mmHg (vs ≤140 mmHg) among Whites and 37% increase risk of CHD death among Blacks. The HR for CHD death among the highest cholesterol group for Whites and Blacks remained doubled (HR: 2.30 and 2.16, respectively).
Conclusions: In contrast to the MRFIT Screenees project, data from a large sample of Veterans receiving medical care do not demonstrate a continuous, graded relationship between cholesterol and 6-year CHD death. Rather, they support a J-shaped relationship where cholesterol levels under 180mg/dl also confer greater risk for CHD death.
Author Disclosures: X.T. Nguyen: None. Y. Ho: None. R.J. Song: None. J. Honerlaw: None. J.L. Vassy: None. D.R. Gagnon: None. K. Cho: None. P.W. Wilson: None.
- © 2016 by American Heart Association, Inc.