OBJECTIVES: The aim of this research was to evaluate the prognostic value of cholesterol absorption assessed with the serum cholestanol-to-cholesterol concentration ratio (lower level reflects decreased cholesterol absorption) among elderly cardiovascular patients (DEBATE [Drugs and Evidence-Based Medicine in the Elderly] study). BACKGROUND: The components of the metabolic syndrome have been unexpectedly associated with better prognosis among elderly cardiovascular patients. On the other hand, a metabolic syndrome-type state is characterized by high synthesis and decreased absorption of cholesterol. METHODS: This was a prospective cohort study of home-dwelling individuals age 75 years and older with cardiovascular diseases (247 women, 129 men) recruited from the community. Main outcome measure was multivariate-adjusted time to 3.4-year mortality and recurrent major cardiovascular events. RESULTS: Serum total and low-density lipoprotein cholesterol levels did not predict outcome. Instead, the mortality risk (64 deaths) increased with increasing levels of cholestanol-to-cholesterol ratio. Patients in the 2nd, 3rd, and 4th quartiles had a relative hazard ratio (HR) for death of 2.54 (95% confidence interval [CI] 1.05 to 6.12), 2.48 (95% CI 1.03 to 6.00), and 3.53 (95% CI 1.52 to 8.19) compared with the lowest quartile, even though 50% of individuals in the lowest cholestanol quartile had metabolic syndrome or diabetes. In multivariate models, the lowest cholestanol ratio quartile was independently associated with lower mortality (relative HR, 0.37, 95% CI 0.17 to 0.81), and with fewer major cardiovascular events (115 events, relative HR, 0.59, 95% CI 0.35 to 0.98). CONCLUSIONS: Low cholesterol absorption was associated with fewer recurrent cardiovascular events, and with better survival in elderly patients despite frequent abnormalities of glucose metabolism.
OBJECTIVES: The aim of this research was to evaluate the prognostic value of cholesterol absorption assessed with the serum cholestanol-to-cholesterol concentration ratio (lower level reflects decreased cholesterol absorption) among elderly cardiovascular patients (DEBATE [Drugs and Evidence-Based Medicine in the Elderly] study). BACKGROUND: The components of the metabolic syndrome have been unexpectedly associated with better prognosis among elderly cardiovascular patients. On the other hand, a metabolic syndrome-type state is characterized by high synthesis and decreased absorption of cholesterol. METHODS: This was a prospective cohort study of home-dwelling individuals age 75 years and older with cardiovascular diseases (247 women, 129 men) recruited from the community. Main outcome measure was multivariate-adjusted time to 3.4-year mortality and recurrent major cardiovascular events. RESULTS: Serum total and low-density lipoprotein cholesterol levels did not predict outcome. Instead, the mortality risk (64 deaths) increased with increasing levels of cholestanol-to-cholesterol ratio. Patients in the 2nd, 3rd, and 4th quartiles had a relative hazard ratio (HR) for death of 2.54 (95% confidence interval [CI] 1.05 to 6.12), 2.48 (95% CI 1.03 to 6.00), and 3.53 (95% CI 1.52 to 8.19) compared with the lowest quartile, even though 50% of individuals in the lowest cholestanol quartile had metabolic syndrome or diabetes. In multivariate models, the lowest cholestanol ratio quartile was independently associated with lower mortality (relative HR, 0.37, 95% CI 0.17 to 0.81), and with fewer major cardiovascular events (115 events, relative HR, 0.59, 95% CI 0.35 to 0.98). CONCLUSIONS: Low cholesterol absorption was associated with fewer recurrent cardiovascular events, and with better survival in elderly patients despite frequent abnormalities of glucose metabolism.
Authors: Pathmaja Paramsothy; Robert H Knopp; Steven E Kahn; Barbara M Retzlaff; Brian Fish; Lina Ma; Richard E Ostlund Journal: Am J Clin Nutr Date: 2011-09-21 Impact factor: 7.045
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Authors: Bernd Genser; Günther Silbernagel; Guy De Backer; Eric Bruckert; Rafael Carmena; M John Chapman; John Deanfield; Olivier S Descamps; Ernst R Rietzschel; Karen C Dias; Winfried März Journal: Eur Heart J Date: 2012-02 Impact factor: 29.983
Authors: Nirupa R Matthan; Lei Zhu; Michael Pencina; Ralph B D'Agostino; Ernst J Schaefer; Alice H Lichtenstein Journal: J Am Heart Assoc Date: 2013-02-19 Impact factor: 5.501