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Serum cholesterol, blood pressure, and mortality: implications from a cohort of 361,662 men
Insights
High serum cholesterol significantly increases coronary heart disease (CHD) mortality risk. A large portion of CHD deaths are linked to elevated cholesterol, supporting moderate fat intake and targeted high-risk treatment.
Area of Science:
- Cardiovascular epidemiology
- Public health
Background:
- Elevated serum cholesterol is a known risk factor for cardiovascular disease.
- Understanding the precise mortality risks associated with different cholesterol levels is crucial for public health interventions.
Purpose of the Study:
- To determine the relationship between serum cholesterol levels and 6-year mortality in a large cohort of middle-aged men.
- To quantify the proportion of coronary heart disease (CHD) deaths attributable to raised serum cholesterol.
Main Methods:
- Analysis of 6-year mortality data from 361,662 men aged 35-57.
- Stratification of participants based on serum cholesterol percentiles.
- Calculation of relative risks for CHD mortality at different cholesterol levels.
Main Results:
- CHD mortality increased progressively with serum cholesterol levels above the 20th percentile (>181 mg/dl).
- Men above the 85th percentile (>253 mg/dl) had a 3.8-fold increased relative risk of CHD mortality.
- Half of all CHD deaths were associated with raised cholesterol, with a significant portion in the highest risk group.
Conclusions:
- Serum cholesterol levels exhibit a risk curve similar to diastolic blood pressure for both CHD and total mortality.
- Evidence supports moderate fat intake for the general population and intensive treatment for individuals with high cholesterol.
- A substantial population segment (10-15%) may benefit from intensive cholesterol management, analogous to hypertension treatment.
Abstract:
The risks associated with various levels of serum cholesterol were determined by analysis of 6-year mortality in 361,662 men aged 35-57. Above the 20th percentile for serum cholesterol (greater than 181 mg/dl, greater than 4.68 mmol/l), coronary heart disease (CHD) mortality increased progressively; the relative risk was large (3.8) in the men with cholesterol levels above the 85th percentile (greater than 253 mg/dl, greater than 6.54 mmol/l). When men below the 20th cholesterol percentile were used as the baseline risk group, half of all CHD deaths were associated with raised serum cholesterol concentrations; half of these excess deaths were in men with cholesterol levels above the 85th percentile. For both CHD and total mortality, serum cholesterol was similar to diastolic blood pressure in the shape of the risk curve and in the size of the high-risk group. This new evidence supports the policy of a moderate fat intake for the general population and intensive treatment for those at high risk. There is a striking analogy between serum cholesterol and blood pressure in the epidemiological basis for identifying a large segment of the population (10-15%) for intensive treatment.