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Total cholesterol and mortality from ischemic heart disease and overall cardiovascular disease in Korean adults.

ABSTRACT: It is not completely clear whether "the lower, the better" cholesterol hypothesis for cardiovascular disease (CVD) and ischemic heart disease (IHD) can be applied to general populations with a low risk of heart disease mortality.We prospectively followed up 503,340 Koreans who participated in routine health checkups during 2002-2003 until 2013 via linkage to national mortality records.Nonlinear associations with total cholesterol (TC) were found: U-curves for overall CVD (I00-I99; nadir at 180-200?mg/dL) and a reverse-L-curve for IHD (I20-I25). Assuming a linear association in the lower range (<200?mg/dL), TC was inversely associated with CVD mortality (HR per 39?mg/dL [1?mmol/L] increase?=?0.90). In the upper range (200-349?mg/dL), TC was positively associated with CVD mortality, largely due to IHD (HR?=?1.19), especially acute myocardial infarction (HR?=?1.23). The associations were generally similar in men versus women and in middle-aged (40-64?years) versus elderly (?65?years) adults.TC levels of 180-200?mg/dL were associated with the lowest CVD mortality. Below 200?mg/dL, TC had no graded positive associations with IHD mortality. It remains unclear whether the lowest cholesterol levels are associated with the least mortality from CVD and IHD in Korean adults with a low risk of heart disease.

SUBMITTER: Kwon D

PROVIDER: S-EPMC6739006 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Total cholesterol and mortality from ischemic heart disease and overall cardiovascular disease in Korean adults.

Kwon Daeho D Yi Jee-Jeon JJ Ohrr Heechoul H Yi Sang-Wook SW

Medicine 20190901 36

It is not completely clear whether "the lower, the better" cholesterol hypothesis for cardiovascular disease (CVD) and ischemic heart disease (IHD) can be applied to general populations with a low risk of heart disease mortality.We prospectively followed up 503,340 Koreans who participated in routine health checkups during 2002-2003 until 2013 via linkage to national mortality records.Nonlinear associations with total cholesterol (TC) were found: U-curves for overall CVD (I00-I99; nadir at 180-2 ...[more]

PMID: 31490384

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Project description:BackgroundRandomized controlled trials have shown the importance of tight glucose control in type 1 diabetes (T1DM), but few recent studies have evaluated the risk of cardiovascular disease (CVD) and all-cause mortality among adults with T1DM. We evaluated these risks in adults with T1DM compared with the non-diabetic population in a nationwide study from Scotland and examined control of CVD risk factors in those with T1DM.Methods and findingsThe Scottish Care Information-Diabetes Collaboration database was used to identify all people registered with T1DM and aged ?20 years in 2005-2007 and to provide risk factor data. Major CVD events and deaths were obtained from the national hospital admissions database and death register. The age-adjusted incidence rate ratio (IRR) for CVD and mortality in T1DM (n?=?21,789) versus the non-diabetic population (3.96 million) was estimated using Poisson regression. The age-adjusted IRR for first CVD event associated with T1DM versus the non-diabetic population was higher in women (3.0: 95% CI 2.4-3.8, p<0.001) than men (2.3: 2.0-2.7, p<0.001) while the IRR for all-cause mortality associated with T1DM was comparable at 2.6 (2.2-3.0, p<0.001) in men and 2.7 (2.2-3.4, p<0.001) in women. Between 2005-2007, among individuals with T1DM, 34 of 123 deaths among 10,173 who were <40 years and 37 of 907 deaths among 12,739 who were ?40 years had an underlying cause of death of coma or diabetic ketoacidosis. Among individuals 60-69 years, approximately three extra deaths per 100 per year occurred among men with T1DM (28.51/1,000 person years at risk), and two per 100 per year for women (17.99/1,000 person years at risk). 28% of those with T1DM were current smokers, 13% achieved target HbA(1c) of <7% and 37% had very poor (?9%) glycaemic control. Among those aged ?40, 37% had blood pressures above even conservative targets (?140/90 mmHg) and 39% of those ?40 years were not on a statin. Although many of these risk factors were comparable to those previously reported in other developed countries, CVD and mortality rates may not be generalizable to other countries. Limitations included lack of information on the specific insulin therapy used.ConclusionsAlthough the relative risks for CVD and total mortality associated with T1DM in this population have declined relative to earlier studies, T1DM continues to be associated with higher CVD and death rates than the non-diabetic population. Risk factor management should be improved to further reduce risk but better treatment approaches for achieving good glycaemic control are badly needed. Please see later in the article for the Editors' Summary.

Dataset Information

Total cholesterol and mortality from ischemic heart disease and overall cardiovascular disease in Korean adults.

Publications

Total cholesterol and mortality from ischemic heart disease and overall cardiovascular disease in Korean adults.

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