Enigma of the cholesterol paradox in acute myocardial infarction: lessons from an 8-year follow-up of all-cause mortality in an age-matched and sex-matched case–control study with controls from the patients’ recruitment area
Objective To assess the impact of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) on long-term all-cause mortality (ACM) in patients with acute myocardial infarction (AMI) and controls.Design Matched case–control study with 8-year follow-up.Setting Vastmanland County Hospital,...
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e057562.full |
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| author | Göran Nilsson John Öhrvik Jerzy Leppert |
| author_facet | Göran Nilsson John Öhrvik Jerzy Leppert |
| author_sort | Göran Nilsson |
| collection | DOAJ |
| description | Objective To assess the impact of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) on long-term all-cause mortality (ACM) in patients with acute myocardial infarction (AMI) and controls.Design Matched case–control study with 8-year follow-up.Setting Vastmanland County Hospital, Vasteras, Sweden.Participants Consecutive patients with AMI admitted to the coronary care unit from March 2005 to May 2010 and age-matched and sex-matched controls from the general population.Outcome measures ACM.Results Person-year at risk among patients with AMI and controls was 11 667 (cases: 5780 and controls: 5887). During follow-up, 199 patients and 84 controls died, implying 3.4 deaths among patients and 1.4 among controls per 100 person-years at risk. Unadjusted Cox analyses showed significantly increasing mortality by decreasing TC and LDL-C levels in both patients (HR=0.70, 95% CI 0.62 to 0.79, p<0.001, and HR=0.64, 95% CI 0.56 to 0.74, p<0.001) and controls (HR=0.73, 95% CI 0.60 to 0.89, p=0.002, and HR=0.74, 95% CI 0.59 to 0.93, p=0.010). After adjusting for clinical variables, the results for the patients remained significant. Cox analyses of the relations between mortality and TC and LDL-C below and above their respective medians revealed the following pattern. Patients: below medians were TC and LDL-C levels significantly inversely related to mortality; above medians there were no relations with mortality. Controls: below medians were TC and LDL-C levels significantly inversely related to mortality; above medians were LDL-C levels significantly positively related to mortality. Mean LDL-C level in patients with blood sampled >12 hours after symptom onset was 0.41 mmol/L lower than that in patients with blood sampled ≤12 hours (p=0.030). This LDL-C decrease was reasonably caused by ongoing AMI and reflects the difference in LDL-C levels between patients and controls.Conclusions In patients with AMI, lower TC and LDL-C levels independently predict higher ACM. In their controls, LDL-C levels above the median independently predict higher ACM. This study adds to the body of evidence supporting the existence of a cholesterol paradox. |
| format | Article |
| id | doaj-art-86d5a9ffa2554c07845c5d1439a1be97 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-86d5a9ffa2554c07845c5d1439a1be972025-01-30T18:20:09ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-057562Enigma of the cholesterol paradox in acute myocardial infarction: lessons from an 8-year follow-up of all-cause mortality in an age-matched and sex-matched case–control study with controls from the patients’ recruitment areaGöran Nilsson0John Öhrvik1Jerzy Leppert2Center for Clinical Research, Vasteras, Faculty of Medicine, Uppsala University, Uppsala, SwedenCentre for Clinical Research Vastmanland Hospital Vasteras, Uppsala University, Uppsala, SwedenCentre for Clinical Research Vastmanland Hospital Vasteras, Uppsala University, Uppsala, SwedenObjective To assess the impact of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) on long-term all-cause mortality (ACM) in patients with acute myocardial infarction (AMI) and controls.Design Matched case–control study with 8-year follow-up.Setting Vastmanland County Hospital, Vasteras, Sweden.Participants Consecutive patients with AMI admitted to the coronary care unit from March 2005 to May 2010 and age-matched and sex-matched controls from the general population.Outcome measures ACM.Results Person-year at risk among patients with AMI and controls was 11 667 (cases: 5780 and controls: 5887). During follow-up, 199 patients and 84 controls died, implying 3.4 deaths among patients and 1.4 among controls per 100 person-years at risk. Unadjusted Cox analyses showed significantly increasing mortality by decreasing TC and LDL-C levels in both patients (HR=0.70, 95% CI 0.62 to 0.79, p<0.001, and HR=0.64, 95% CI 0.56 to 0.74, p<0.001) and controls (HR=0.73, 95% CI 0.60 to 0.89, p=0.002, and HR=0.74, 95% CI 0.59 to 0.93, p=0.010). After adjusting for clinical variables, the results for the patients remained significant. Cox analyses of the relations between mortality and TC and LDL-C below and above their respective medians revealed the following pattern. Patients: below medians were TC and LDL-C levels significantly inversely related to mortality; above medians there were no relations with mortality. Controls: below medians were TC and LDL-C levels significantly inversely related to mortality; above medians were LDL-C levels significantly positively related to mortality. Mean LDL-C level in patients with blood sampled >12 hours after symptom onset was 0.41 mmol/L lower than that in patients with blood sampled ≤12 hours (p=0.030). This LDL-C decrease was reasonably caused by ongoing AMI and reflects the difference in LDL-C levels between patients and controls.Conclusions In patients with AMI, lower TC and LDL-C levels independently predict higher ACM. In their controls, LDL-C levels above the median independently predict higher ACM. This study adds to the body of evidence supporting the existence of a cholesterol paradox.https://bmjopen.bmj.com/content/12/7/e057562.full |
| spellingShingle | Göran Nilsson John Öhrvik Jerzy Leppert Enigma of the cholesterol paradox in acute myocardial infarction: lessons from an 8-year follow-up of all-cause mortality in an age-matched and sex-matched case–control study with controls from the patients’ recruitment area BMJ Open |
| title | Enigma of the cholesterol paradox in acute myocardial infarction: lessons from an 8-year follow-up of all-cause mortality in an age-matched and sex-matched case–control study with controls from the patients’ recruitment area |
| title_full | Enigma of the cholesterol paradox in acute myocardial infarction: lessons from an 8-year follow-up of all-cause mortality in an age-matched and sex-matched case–control study with controls from the patients’ recruitment area |
| title_fullStr | Enigma of the cholesterol paradox in acute myocardial infarction: lessons from an 8-year follow-up of all-cause mortality in an age-matched and sex-matched case–control study with controls from the patients’ recruitment area |
| title_full_unstemmed | Enigma of the cholesterol paradox in acute myocardial infarction: lessons from an 8-year follow-up of all-cause mortality in an age-matched and sex-matched case–control study with controls from the patients’ recruitment area |
| title_short | Enigma of the cholesterol paradox in acute myocardial infarction: lessons from an 8-year follow-up of all-cause mortality in an age-matched and sex-matched case–control study with controls from the patients’ recruitment area |
| title_sort | enigma of the cholesterol paradox in acute myocardial infarction lessons from an 8 year follow up of all cause mortality in an age matched and sex matched case control study with controls from the patients recruitment area |
| url | https://bmjopen.bmj.com/content/12/7/e057562.full |
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