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A review of observational studies on the relationship between cholesterol and coronary heart disease
1Faculty of Health and Medical Sciences, University of Wollongong, NSW.
Insights
High plasma cholesterol concentration is a confirmed cause of coronary heart disease (CHD). This conclusion is supported by extensive evidence from epidemiological, clinical, animal, and laboratory studies, fulfilling Bradford Hill
Area of Science:
- Epidemiology and Public Health
- Cardiovascular Science
Background:
- Evaluating the causal link between observed associations and disease is crucial in epidemiology.
- Bradford Hill's criteria provide a framework for assessing causality in observational studies.
- High plasma cholesterol is a suspected risk factor for coronary heart disease (CHD).
Purpose of the Study:
- To evaluate the causal relationship between abnormal plasma cholesterol and lipoprotein concentrations and coronary heart disease (CHD).
- To apply Bradford Hill's criteria to existing evidence on cholesterol and CHD.
Main Methods:
- Systematic review and synthesis of evidence from epidemiological studies.
- Integration of findings with supporting data from clinical trials, animal research, and laboratory investigations.
- Application of Bradford Hill's criteria for causality assessment.
Main Results:
- Overwhelming evidence from observational studies indicates a strong association between high plasma cholesterol and CHD.
- Supporting evidence from clinical, animal, and laboratory studies corroborates the causal link.
- The evidence consistently satisfies multiple criteria for causality, including strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experiment, and analogy.
Conclusions:
- High plasma cholesterol concentration is definitively established as a cause of coronary heart disease (CHD).
- The application of Bradford Hill's criteria provides robust support for the causal role of cholesterol in CHD.
- These findings underscore the importance of managing plasma cholesterol levels for cardiovascular health.
Abstract:
The likelihood that an association observed in epidemiological studies is one of cause and effect is often evaluated using criteria first put forward by Bradford Hill. The evidence on whether abnormal concentrations of cholesterol and lipoproteins in the blood plasma cause coronary heart disease (CHD) is considered using Bradford Hill's criteria. Evidence from observational studies, backed by evidence from clinical, animal and laboratory studies, leaves no doubt that a high plasma cholesterol concentration is a cause of CHD.