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Glucose-cholesterol interaction magnifies coronary heart disease risk for hypertensive patients

Hillel W Cohen1, Susan M Hailpern, Michael H Alderman

  • 1Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA. hicohen@aecom.yu.edu

Hypertension (Dallas, Tex. : 1979)
|March 24, 2004
PubMed

Insights

High cholesterol and glucose levels synergistically increase coronary heart disease risk in treated hypertensive patients. This interaction suggests modifying cholesterol treatment guidelines based on glucose status may improve prevention.

Area of Science:

  • Cardiovascular Medicine
  • Metabolic Disorders
  • Epidemiology

Background:

  • Elevated cholesterol and glucose are independent risk factors for coronary heart disease (CHD).
  • Hypertension is a significant contributor to cardiovascular complications.
  • The synergistic effect of cholesterol and glucose on CHD risk in treated hypertensive patients requires further investigation.

Purpose of the Study:

  • To investigate the synergistic interaction between total cholesterol and fasting glucose levels in magnifying coronary heart disease risk among treated hypertensive patients.
  • To determine if combined elevations in cholesterol and glucose pose a greater CHD risk than their individual effects.
  • To explore potential modifications in cholesterol intervention criteria based on glucose status for enhanced CHD prevention.

Main Methods:

  • A cohort of 6672 treated hypertensive patients from a worksite program was analyzed.
  • Participants had entry fasting glucose <6.99 mmol/L and total cholesterol <6.72 mmol/L.
  • Follow-up averaged 5.6 years, with incident hospitalization or death due to CHD as outcome events.
  • Cox proportional hazard models were used to assess the interaction between total cholesterol and fasting glucose, adjusting for other CHD risk factors.

Main Results:

  • A significant synergistic interaction (P=0.009) was found between total cholesterol and fasting glucose in predicting CHD risk.
  • Hazard ratios for higher total cholesterol categories were more than double in the higher fasting glucose stratum compared to the lower stratum.
  • This magnification of risk was consistent regardless of the fasting glucose threshold used (impaired fasting glucose or upper quartile).

Conclusions:

  • An adverse synergistic interaction between glucose and cholesterol significantly magnifies coronary heart disease risk in treated hypertensive patients.
  • Current cholesterol intervention criteria may need to be modified by glucose status to optimize CHD prevention strategies.
  • This finding highlights the importance of managing both glucose and cholesterol concurrently in hypertensive individuals to mitigate cardiovascular risk.

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