1. Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study
- Author
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Calle Bengtsson, Johann A. Sigurdsson, Linn Getz, Halfdan Petursson, and Tom Ivar Lund Nilsen
- Subjects
education.field_of_study ,medicine.medical_specialty ,Pediatrics ,business.industry ,Proportional hazards model ,Health Policy ,Population ,Hazard ratio ,Public Health, Environmental and Occupational Health ,Confidence interval ,Epidemiology ,Medicine ,Population study ,Risk factor ,education ,business ,Prospective cohort study ,Algorithm - Abstract
Rationale, aims and objectives Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol is a frequently used variable in the risk estimates. Some studies indicate that the predictive properties of cholesterol might not be as straightforward as widely assumed. Our aim was to document the strength and validity of total cholesterol as a risk factor for mortality in a well-defined, general Norwegian population without known CVD at baseline. Methods We assessed the association of total serum cholesterol with total mortality, as well as mortality from CVD and ischaemic heart disease (IHD), using Cox proportional hazard models. The study population comprises 52 087 Norwegians, aged 20‐74, who participated in the Nord-Trondelag Health Study (HUNT 2, 1995‐1997) and were followed-up on cause-specific mortality for 10 years (510 297 person-years in total). Results Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95% confidence interval (CI): 0.89‐0.99 per 1.0 mmol L -1 increase] as well as CVD mortality (HR: 0.97; 95% CI: 0.88‐1.07). The association with IHD mortality (HR: 1.07; 95% CI: 0.92‐1.24) was not linear but seemed to follow a ‘U-shaped’ curve, with the highest mortality
- Published
- 2011