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Serum cholesterol in patients undergoing cardiac catheterization for suspected coronary artery disease: diagnostic
R M Califf1, K S Pieper, W R Harlan
1Department of Medicine, Duke University Medical Center, Durham, NC 27710.
Insights
Cholesterol levels are linked to coronary artery disease presence, but not cardiovascular death or events in treated patients. Age, not gender, significantly impacts this relationship.
Area of Science:
- Cardiology
- Epidemiology
- Biochemistry
Background:
- The Duke Data Bank for Cardiovascular Diseases contains patient data for coronary artery disease (CAD) evaluation.
- Baseline cholesterol levels were analyzed in patients undergoing diagnostic angiography.
Purpose of the Study:
- To investigate the relationship between baseline cholesterol levels and the presence of coronary artery disease.
- To determine if cholesterol levels predict cardiovascular death or events in medically or surgically treated patients.
- To assess the association between lipid profiles and restenosis after percutaneous coronary angioplasty (PCI).
Main Methods:
- Observational analysis of 6829 patients from the Duke Data Bank (1969-1990).
- Cox proportional hazards model for subgroup analyses of treated patients (n=2038 medically, n=1798 surgically).
- Detailed lipid analysis in 759 patients undergoing PCI (1986-1989).
Main Results:
- Baseline total cholesterol correlated with CAD presence in men and women, but less so in the elderly.
- A significant interaction was found between age and cholesterol, but not gender and cholesterol.
- No significant relationship was observed between cholesterol levels and cardiovascular death or cardiac events in either medically or surgically treated subgroups.
- No substantial association was found between baseline or follow-up lipid levels and restenosis post-PCI.
Conclusions:
- While baseline cholesterol is related to CAD presence, it does not predict long-term outcomes in treated patients.
- Age is a significant factor interacting with cholesterol's effect on CAD.
- Lipid profiles, including cholesterol, LDL, HDL, and triglycerides, do not appear to be significant predictors of restenosis after PCI.
Abstract:
The Duke Data Bank for Cardiovascular Diseases is an observational data bank capturing baseline, treatment, and follow-up information on patients referred for evaluation of suspected coronary artery disease. From 6829 patients referred between 1969 and 1990 for diagnostic angiography, baseline cholesterol levels were determined as part of the standard clinical procedure. Baseline total cholesterol values were found to be related to the presence of coronary disease in men and women, although in the elderly little evidence for a significant relationship was found. Formal tests for interactions revealed a significant interaction between age and cholesterol but not between gender and cholesterol. In subgroup analyses using the Cox proportional hazards model, no relationship was found between cholesterol and either cardiovascular death or total cardiac events (death or nonfatal myocardial infarction) in 2038 medically treated patients with 5 to 20 years of follow-up. In the subgroup of 1798 surgically treated patients, there was also no relationship between baseline cholesterol level and these end points. Finally, detailed lipid analysis was done at baseline and 6-month angiography in a second population of 759 patients undergoing percutaneous coronary angioplasty between 1986 and 1989. No substantial relationship between baseline or follow-up cholesterol, low-density or high-density lipoproteins, or triglyceride levels and restenosis was found.