Caterina Bonfiglio1, Carla M Leone1, Liciana V A Silveira2, Rocco Guerra1, Giovanni Misciagna3, Maria G Caruso4, Irene Bruno1, Claudia Buongiorno1, Angelo Campanella1, Vito M B Guerra1, Maria Notarnicola5, Valentina Deflorio1, Isabella Franco1, Antonella Bianco1, Antonella Mirizzi1, Laura R Aballay6, Anna M Cisternino7, Paolo Sorino1, Pasqua L Pesole8, Alberto R Osella9. 1. Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino). 2. Department of Biostatistics, Biosciences Institute, São Paulo State University, Av Rubião Jr.-Centro, Botucatu-SP, 18618-970 Botucatu, São Paulo, Brazil (Liciana V.A. Silveira). 3. Scientific and Ethical Committee, Policlinic Hospital, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, BA, Italy (Giovanni Misciagna). 4. Laboratory of Nutritional Biochemistry National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Maria Gabriella Caruso, Maria Notarnicola); Clinical Nutrition Outpatient Clinic National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Anna Maria Cisternino). 5. Laboratory of Nutritional Biochemistry National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Maria Gabriella Caruso, Maria Notarnicola). 6. Human Nutrition Research Center (CenINH), School of Nutrition, Faculty of Medical Sciences, Universidad Nacional de Córdoba, Córdoba, Argentina; Enrique Barros Pabellón Biología Celular, Ciudad Universitaria, X5000 Córdoba, Argentina. 7. Clinical Nutrition Outpatient Clinic National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Anna Maria Cisternino). 8. Laboratory of Clinical Pathology, National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Pasqua Letizia Pesole). 9. Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino). Electronic address: arosella@irccsdebellis.it.
Abstract
BACKGROUND AND AIMS: Cardiovascular diseases (CVDis) are leading causes of morbidity and mortality. Even after the introduction of pharmacological therapy to lower Cholesterol, there is still a residual risk that may be ascribed to remnant cholesterol (RC). We aimed, by analyzing two prospective cohort studies, to estimate the effect of RC on risk and hazard of cardiovascular deaths (CVDs), while accounting for competing risks such as cancer (CDs) and other-causes deaths (OCDs). METHODS AND RESULTS: Cohorts were enrolled in 1992 and 2005. Personal data history was recorded. A fasting venous blood sample was obtained, and RC was calculated at baseline. Cause of Death was coded by using ICD-10th version. Follow-up ended on December 31, 2017. Flexible parametric competing-risks models were applied, with age at death as time-axis. In total, 5729 subjects were enrolled. There were 861 (15.1%) deaths: 234 CVDs (27.2%), 245 CDs (28.5%), 271 OCDs (31.5%) and 111 unknown causes of death (12.8%). RC exposure was a strong risk factor only for CVDs (Risk 2.54, 95% Confidence Interval 1.21; 5.34; Trend 1.26 (1.00; 1.58) for ≥1.29 mmol/L). CONCLUSIONS: RC is a strong independent risk factor for cardiovascular mortality. Competing risk analysis is demonstrably a useful tool to disentangle associations among different competing events with a common risk factor.
BACKGROUND AND AIMS: Cardiovascular diseases (CVDis) are leading causes of morbidity and mortality. Even after the introduction of pharmacological therapy to lower Cholesterol, there is still a residual risk that may be ascribed to remnant cholesterol (RC). We aimed, by analyzing two prospective cohort studies, to estimate the effect of RC on risk and hazard of cardiovascular deaths (CVDs), while accounting for competing risks such as cancer (CDs) and other-causes deaths (OCDs). METHODS AND RESULTS: Cohorts were enrolled in 1992 and 2005. Personal data history was recorded. A fasting venous blood sample was obtained, and RC was calculated at baseline. Cause of Death was coded by using ICD-10th version. Follow-up ended on December 31, 2017. Flexible parametric competing-risks models were applied, with age at death as time-axis. In total, 5729 subjects were enrolled. There were 861 (15.1%) deaths: 234 CVDs (27.2%), 245 CDs (28.5%), 271 OCDs (31.5%) and 111 unknown causes of death (12.8%). RC exposure was a strong risk factor only for CVDs (Risk 2.54, 95% Confidence Interval 1.21; 5.34; Trend 1.26 (1.00; 1.58) for ≥1.29 mmol/L). CONCLUSIONS: RC is a strong independent risk factor for cardiovascular mortality. Competing risk analysis is demonstrably a useful tool to disentangle associations among different competing events with a common risk factor.
Authors: Antonella Mirizzi; Laura R Aballay; Giovanni Misciagna; Maria G Caruso; Caterina Bonfiglio; Paolo Sorino; Antonella Bianco; Angelo Campanella; Isabella Franco; Ritanna Curci; Filippo Procino; Anna M Cisternino; Maria Notarnicola; Pierina F D'Aprile; Alberto R Osella Journal: Nutrients Date: 2021-11-10 Impact factor: 5.717