Risk of Hypercholesterolemia for Cardiovascular Disease and the Population Attributable Fraction in a 24-year Japanese Cohort Study

Abstract

Aims:The population-attributable fraction (PAF) is an indicator of the disease burden. In Western countries, the PAF of hypercholesterolemia in cardiovascular disease (CVD) is the highest among that for traditional risk factors; however, data for Asian populations are limited. Methods: A 24-year cohort study was conducted among 9,209 randomly selected participants who were not taking statins. We estimated the hazard ratio (HR) after adjusting for covariates and PAF associated with the serum total cholesterol (TC) levels in relation to CVD mortality. Results: The TC level was found to be positively associated with an increased risk of CVD, coronary heart disease (CHD) and cardiac death (CHD plus heart failure), with an HR of 1.08 (95% confidence interval [CI]: 1.00-1.16), 1.33 (95% CI: 1.14-1.55) and 1.21 (95% CI: 1.08-1.35) for a 1-SD increment in the serum TC level, respectively. Similar positive associations between the TC level and both CHD and cardiac death were observed after classifying the patients by age and sex. Furthermore, the highest serum TC level (≥ 6.72 mmol/L) was positively associated with CVD death, with an HR of 1.76 (95% CI: 1.25-2.47), as well as both CHD death and cardiac death. In contrast, no significant relationships were observed between the serum TC level and stroke. Meanwhile, the PAF for CVD, CHD, and cardiac deaths due to hypercholesterolemia (serum TC level ≥ 5.69 mmol/L, defined by the Japan Atherosclerosis Society) was 1.7%, 10.6% and 5.6%, respectively. Conclusions: The estimated PAF of CVD death due to hypercholesterolemia is moderately high, but lower than that for other risk factors, such as hypertension.J Atheroscler Thromb, 2015; 22:95-107.

Association of Total Energy Intake with 29-Year Mortality in the Japanese: NIPPON DATA80

“…Although impact of higher saturated fat intake and hypercholesterolemia on CHD among Japanese populations have been reported 43,44) , previous studies on total energy intake have shown either no association or an inverse association with CVD mortality or incidence 8,[11][12][13][14] . The reasons for the observed inconsistency between the previous studies and ours are items enhanced the association between the total energy intake and mortality.…”

Association of Treatment for Hyperlipidemia with Decreased Total Mortality in Japanese Individuals: the Yamagata (Takahata) Study

“…Surprisingly, several studies in the general Japanese population showed that total mortality was decreased in subjects with higher total cholesterol levels or hyperlipidemia 48,49) , while a nationwide study showed that subjects with the highest total cholesterol levels had the highest total mortality [50][51][52] . Thus, to examine this issue further, we determined the association between total cholesterol levels [divided into three groups, high (total cholesterol ≥ 240 mg/dL), middle (180 -239 mg/dL), and low (≤ 179 mg/dL)] and total mortality in our study sample.…”

The Relationship between Very High Levels of Serum High-Density Lipoprotein Cholesterol and Cause-Specific Mortality in a 20-Year Follow-Up Study of Japanese General Population

“…NIPPON DATA included two long-term cohort studies. The baseline surveys were performed in 1980 and in 1990 (NIPPON DATA80 and NIPPON DATA90), and the details of these cohorts have been reported 14,[16][17][18][19] . In this study, we analyzed data from NIPPON DATA90 because the baseline survey of NIPPON DATA80 did not include the measurement of serum HDL-C.…”