Cholesterol and coronary heart disease: future directions

Article Abstract:

High blood cholesterol levels are now known to be associated with coronary heart disease (CHD), and the National Cholesterol Education Program (NCEP) began to implement suggestions to reduce cholesterol levels in 1985. Unresolved issues remain, however, in determining how strong the links are between cholesterol levels and CHD; these issues are reviewed. Although most CHD occurs in older people (over age 60), clinical trials of the effectiveness of lowering blood cholesterol have not been carried out for men or women in this age group. Whether intervention should begin in childhood is debated. The importance of triglyceride levels, another form in which fats can be stored, is not known, but elevated triglycerides are an independent risk factor for CHD, apart from elevated cholesterol. Low levels of high-density-lipoprotein cholesterol (HDL-C), one form of cholesterol, appear to be the single best predictor of CHD. Physicians should have access to accurate values for all the lipoproteins that may be important in this context, but measurement problems still exist. While diet is often considered a major cause of hypercholesterolemia (high blood cholesterol levels), many cases stem from genetic causes. Nor will dietary improvement affect all people equally; some may be poor responders to changes in the diet. Optimal diets are evaluated. Obesity, usually ranked behind diet as a risk factor for hypercholesterolemia, may be even more important. It is also associated with other diseases, such as hypertension and diabetes. Cholesterol-lowering drugs currently in use are reviewed. Better programs are needed to identify people who would benefit from early treatment to lower their cholesterol levels. Even when patients develop CHD, the rate of disease progression slows if they control their cholesterol levels. Lowering cholesterol to prevent CHD is a costly undertaking, and the merits of controlling this risk factor should be weighed against the merits of controlling others, such as smoking and hypertension. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Complications and side effects, Physiological aspects, Demographic aspects, Low-fat diet, Low fat diet, Hypercholesterolemia, Anticholesteremic agents

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A single cholesterol measurement underestimates the risk of coronary heart disease: an empirical example from the lipid research clinics mortality follow-up study

Article Abstract:

Prospective epidemiological studies measure subjects' risk factors at a particular time, and then follow the subjects to observe the occurrence of the disease or event for which risk factor data were collected. Usually, only one measurement of the risk factor is made: if this value is not representative, then the actual link between the risk factor and the real risk for the population will be stronger than estimated (following from statistical theory). This fact is called the ''errors in variables'' problem or the ''regression dilution effect''. It is illustrated using the Lipid Research Clinics Mortality Follow-up Study data, which relied on two determinations several years apart of men's cholesterol levels. More than 2,000 men participated. Of interest was the agreement between the two cholesterol measurements and the accuracy of their prediction of coronary heart disease or cardiovascular disease (CHD or CVD). Results are stated in terms of regression coefficients, a measure of the relatedness of two variables. The regression coefficient for cholesterol and CHD increased from 0.4257 or 0.4528 (visits 1 and 2) to 0.4959, when both values were averaged. For CVD, the values were 0.3351 and 0.3405 (visits 1 and 2), but 0.3798 when data from both visits were averaged. This suggests that using only one cholesterol value causes an underestimate of the strength of the relationship between cholesterol and risk for either type of disease. Such variability will be reduced by methods that allow more standardized, repeatable analyses, and that account for true variability within the individual. A statistical explanation of the results is presented. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Measurement, Statistics, Risk factors (Health), Blood cholesterol

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