Average Serum Cholesterol Research Articles

Association between statin therapy and long-term clinical outcomes in patients with stable coronary disease undergoing percutaneous coronary intervention

This longitudinal cohort study examined the long-term effect of statin therapy on clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). A total of 1760 patients with stable coronary artery disease (CAD) were divided by receipt of statin therapy or not after index PCI. Baseline clinical characteristics, risk factors, angiographic findings, and medications after interventional procedure were assessed to compare long-term clinical outcomes between groups. Predictors for all-cause death and major adverse cardiovascular events (MACE), including myocardial infarction (MI), cardiovascular death, and repeated PCI procedures, were also analyzed. The statin therapy group had higher average serum cholesterol and more elevated low-density lipoprotein cholesterol (LDL-C) than the non-statin therapy group (189.0 ± 47.9 vs 169.3 ± 37.00 mg/dl, 117.2 ± 42.6 vs 98.7 ± 31.8 mg/dl, respectively, both P < 0.001). The non-statin group had higher rates of all-cause death and cardiovascular death compared to statin group (both P < 0.001). After adjustment for age, diabetes, and chronic kidney disease, Cox proportion hazard analysis revealed statin use significantly reduced all-cause death and repeated PCI procedure (hazard ratio: 0.53 and 0.69, respectively). Statin use seemed not reduce the hazard of cardiovascular death or MI in patients with stable CAD after PCI; however, statin therapy still was associated with reduced rates of all-cause death and repeat PCI procedure.

Association of serum cholesterol with coronary heart disease mortality during 50-year follow-up in ten cohorts of the seven countries study

Background and aimThe association of serum cholesterol levels with the occurrence of coronary heart disease (CHD) mortality during a follow-up of 50 years was rarely investigated previously. Thus, we took advantage of results at hand in 10 pooled cohorts of men aged 40–59 years from the Seven Countries Study (9063 individuals and 2057 CHD fatal events) and we assessed this. Methods and resultsCox proportional hazards models were run with CHD fatal events (as dependent variable) and cholesterol levels (as independent variables) at years 0, 10, and 25 (in 5 cohorts). Cumulative events during subsequent decades (cumulative approach: CA) and separately in each subsequent decade (partitioned approach: PA) were analyzed.The ecological correlation of average baseline serum cholesterol levels with CHD mortality was very high (R = 0.97). Serum cholesterol and CHD mortality for 50 years were associated at the individual level, and the association estimated by the Cox's coefficients (and related hazards ratios) was initially strong in both CA and PA, but slightly declined during later decades. Hazards ratios (for a difference of 40 mg/dl) ranged from 1.39 to 1.20 for CA and from 1.39 to 0.80 for PA. Coefficients were larger for CA than for PA and the decline was more evident for the latter. Partitioned coefficient became negative and significant in the last decade (from year 40–50). Coefficients derived from cholesterol levels measured at year 10 of follow-up showed similar trends but their magnitude was smaller. ConclusionThus, the relationship of serum cholesterol levels with CHD mortality remained relatively stable during at least 40 years after a single cholesterol measurement at baseline in middle-aged men.

Effect of feeding of calcium treated soybean straw over untreated soybean straw on blood biochemical profile of lactating cows

In present investigation 10 lactating cows were distributed into four treatment T1, T2, T3, and T4, with 5 cows in each group. Treatment consist of T1- untreated SBS, T2-2% calcium treated SBS. Average plasma glucose in T1- 48.69, 48.77, 48.81, and T2- 47.52, 52.84, 53.21 (mg/dl). The average serum total protein content (mg/dl) 5.92, 6.02, 6.35in T1 and 5.76, 6.15, 7.22 in T2. The average blood urea nitrogen content in T1 13.99, 17.26, 17.47 and 14.28, 17.32, 18.41 in T2 (mg/dl). The average total serum lipid content in T1 272.51, 278.70, 283.60 and 277.02, 300.38, 315.53 (mg/dl) in T2. Average total serum cholesterol content in T1- 59.92, 70.80, 74.95 and T2- 60.94, 70.29, 76.27 (mg/dl). Average total serum triglyceride content in T1- 16.07, 17.26, 17.48 and T2- 16.22, 17.98, 17.89 (mg/dl) in the month of February, April and June, respectively.

Selenium-methionine and chromium-methionine supplementation of sheep around parturition: impacts on dam and offspring performance

ABSTRACTTo examine the effects of maternal energy restriction along with selenium-methionine (Se-Met) and chromium-methionine (Cr-Met) supplementation on performance of pregnant sheep and their offspring, the following treatments were allotted randomly to 40 multiparous Baluchi ewes (53.9 ± 1.15 kg of body weight [BW]) from 5 weeks prior to 5 weeks after parturition: (1) Control diet (60% and 100% of NRC energy requirements in pre- and post-partum, respectively); (2) Control diet plus 5 mg Se-Met/kg dry matter (DM); (3) Control diet plus 3 mg Cr-Met/kg DM and (4) Control diet plus 5 mg Se-Met and 3 mg Cr-Met/kg DM (Se–Cr-Met) of concentrate diet. The results indicated that Cr-Met alone or in combination with Se-Met increased average DM intake of ewes. In addition, Group Cr-Met had higher average BW than the Control (p < 0.05). Se-Met and/or Cr-Met supplementation led to decreased average serum cholesterol of the ewes (p < 0.05). Groups Cr-Met and Se–Cr-Met displayed decreased average serum malondialdehyde compared to the Control (p < 0.05). At 24 h post-partum, Group Se–Cr-Met had a greater serum Se content than the Control (p = 0.006). Compared with the Control, the Se concentration in milk was significantly increased from 30 to 138 µg/l and 197 µg/l in Groups Se-Met and Se–Cr-Met, respectively (p < 0.01), which proved that Se-Met supplementation can increase the Se concentration of ewe milk. Furthermore, feeding Cr-Met may attenuate BW loss post-partum and Se-Met and/or Cr-Met supplements may ameliorate oxidative stress condition in ewes around parturition.

Trends in serum total cholesterol and dietary fat intakes in New Zealand between 1989 and 2009

ObjectiveTo describe trends in serum cholesterol and dietary fat intakes for New Zealand adults between 1989 and 2008/09. MethodsSerum total cholesterol concentrations and dietary fat intakes were analysed for 9,346 New Zealanders aged 15–98 years (52% women) who participated in three national surveys in 1989, 1997 and 2008/09. ResultsPopulation mean serum cholesterol decreased from 6.15 mmol/L in 1989 to 5.39 mmol/L in 2008/09. Mean saturated fat intake decreased from 15.9% of energy intake in 1989 to 13.1% in 2008/09. Between 1997 and 2008/09, unsaturated fat intake increased and fat from butter and milk decreased. Older adults had the largest decrease in serum cholesterol (1.35 mmol/L). ConclusionsThe decrease in serum cholesterol is substantially larger than reported for many other high‐income countries, and occurred in parallel with changes in dietary fat intakes and, for older adults, increased use of cholesterol‐lowering medications. ImplicationGiven the demonstrated role of reduced saturated fat intake on lowering serum cholesterol, and as population average serum cholesterol levels and saturated fat intakes exceed recommended levels, initiatives to further encourage reductions in saturated fat are imperative.

Cardiovascular Diseases Risk Factors in oil and gas workers: a ten years observational retrospective cohort.

The study aim was to examine the trend of major clinical biochemistry factors associated with cardiovascular diseases and dyslipidemia onset over a 10-year period (2000-2010) in Oil and Gas workers. The information extracted from "Computerized management of individual medical services database" regarding 439 Italian workers of an oil and gas company were analysed. A constant and significant increase of the average Body Mass Index and serum cholesterol were found, and in particular in workers < 36 years: BMI was 24.4 (2000) and 25.8 (2010) with p < 0.001, and cholesterol was 188.3 mg/dL (2000) and 206.5 mg/dL (2010) with p < 0.001. Analysed variables are the most important risk factor for cardiovascular, neurological and neoplastic diseases, as well as they reduce life expectancy. Occupational medicine in particular in extreme working environmental conditions, such as for workers in oil and gas companies, monitoring health status and promoting healthy life style, has a strategic role to perform cost-effective strategies to reduce health risks, thus improving the workers lifestyle.

Biochemical Status During Oestrus Cycle in Regular and Repeat Breeding Cows

The present study was undertaken at cattle breeding farm of Nagpur Veterinary College, Nagpur. Serum biochemical profile of repeat breeding cross bred (jersey x Sahiwal) cows was evaluated and compared with that of regular breeding cows. The average total serum total protein, serum calcium and serum inorganic phosphorus values in repeat breeding cows were significantly (P>0.01) lower than the values in regular breeding cows. The average serum cholesterol in repeat breeding cows was significantly (P>0.05) lower than the value of regular breeding cows. The difference in the values of serum total protein, serum cholesterol and serum inorganic phosphorus on 0, 7th, and 15th days of oestrus cycle in regular and repeat breeding cows was found to be non significant. However, significantly (P>0.05) higher values of serum calcium were recorded in regular and repeat breeding cows on 0 day, which significantly decreased on 7th and slightly increased on 15th day of oestrus cycle.

How the Seven Countries Study contributed to the definition and development of the Mediterranean diet concept: A 50-year journey

The Seven Countries Study of Cardiovascular Diseases was started at the end of the 1950s and it continues to be run after >50 years. It enrolled, at entry, 16 population cohorts in eight nations of seven countries for a total of 12,763 middle-aged men. It was the prototype of epidemiological studies seeking cultural contrasts and the first to compare cardiovascular disease (CVD) rates related to diet differences. The study has shown that populations suffer widely different incidence and mortality rates from coronary heart disease (CHD) as well as from other CVDs and overall mortality. Higher rates were found in North America and northern Europe, and lower rates in southern Europe – Mediterranean countries – and Japan. These differences in CHD rates were strongly associated with different levels of saturated fat consumption and average serum cholesterol levels, with lowest rates in Greece and Japan where the total fat intake was very different. The cohorts were also different in dietary patterns defined by the ratio of calories derived from plant foods and fish on the one hand and calories derived from animal foods and sugar on the other. These findings pointed to the so-called Mediterranean diet, which is characterized by large values of that plant/animal ratio, a pattern associated with lower incidence and mortality from CHD and also with the lowest death rates and the greatest survival rates. More recent studies have refined these concepts and documented on a larger scale the virtues of these eating habits.

Treatment of cutaneous T-cell lymphoma with oral alitretinoin.

Cutaneous T-cell lymphoma (CTCL) is a potentially life-limiting malignant disease. Treatment strategies in CTCL aim at disease control and remission with the lowest possible side-effects. Recent reports suggest that the new vitamin A derivative alitretinoin might be a well-tolerated treatment option. We analysed the files of 11 CTCL patients with mycosis fungoides (n = 10) or Sézary syndrome (n = 1), who were treated with oral alitretinoin alone or in combination with standard treatment based on individual off-label treatment decisions. Patients had been monitored every 4-8 weeks with skin examination and laboratory analyses. Ten of 11 patients (90.9%) showed a marked improvement of their CTCL skin lesions and no progress of the disease during treatment with alitretinoin, one patient showed no response to the treatment (9.1%). Four of the responding patients (40.0%) had a complete response and 6 (60.0%) had a partial response. Average time to response was 2.5 months. Duration of treatment varied depending on whether patients had reached complete or partial remission. In general, alitretinoin was well tolerated. One of 11 patients developed high non-fasting average serum cholesterol (>300 mg/dL) and 1/11 a mean non-fasting triglyceride value >500 mg/dL. In 3/11 patients, thyroid-stimulating hormone declined without clinical symptoms during treatment, with one of the patients also showing a decreased thyroxin level. In our group of CTCL patients we noticed a low rate of side-effects and an overall good clinical response to treatment with alitretinoin. Further studies are required to substantiate this early clinical observation.

THU0015 Efficacy versus Safety of Prednisone in Lupus Nephritis since 1988

BackgroundMorbidity and damage due to prednisone use in the treatment of SLE is recognized, but prednisone has been a requisite of lupus nephritis induction regimens. We examined, by calendar years,...

Effects of different oils and fats on the blood lipids of normal service personnel

A trial was undertaken to study the relative effects of rations containing oil hydrogenated, a vegetable oil (mustard oil) and milk ghee on serum cholesterol of 30 recruits obtained from one of the Regimental Centers. The study was carried out for a total period of 3 months. The results of the study indicated that there is significant decrease in the average serum cholesterol of the subjects when they were maintained on rations containing vegetable oil. The study thus confirms the current trend and thoughts on the effect of diets high in saturated fat and low in essential fatty acids in increasing serum cholesterol as compared to a diet high in essential fatty acids.

CZYNNIKI RYZYKA CHORÓB UKŁADU KRĄŻENIA (CVD) A STRES ŻYCIOWY I ZAWODOWY U POLICJANTÓW

Several studies have shown an association between work-related stress and risk factors for cardiovascular disease. ever, only a few studies concerned the police. The aim of this study was to assess the relationship between the general and work-related stress, and the functioning of the circulatory system in the police staff. The study group consisted of 126 policemen (aged 37.8 +/- 7.3 years), with average employment duration of 14.4 +/- 7 years. The study comprised the assessment of health status based on the medical examination and medical history of identified diseases, cardiovascular risk factors and symptoms, dietary habits, physical activity, intake of drugs, data on the family history, determinations of serum total cholesterol, HDL and LDL fractions, triglycerides, and fasting glycemia . The stress level was assessed using the Questionnaire for the Subjective Assessment of Work and Perceived Stress Scale. On medical examination hypertension was found in 36% of the people under study. Chest discomfort was reported by 60% of the subjects. Average body mass index (BMI), serum cholesterol and LDI, were elevated (22.7 +/- 4.1, 222.6 +/- 41.7 mg/dl and 142.7 +/- 39.7 mg/dl, respectively). Mean triglyceride, HDL fraction and fasting glucose levels were normal in the whole group. The levels of general and occupational stress were 34.914.8 and 128.0+33.3, respectively, being higher than in other occupational groups. In the group with the highest level of stress, there were significantly more people with circulatory problems (81%), drinking strong alcohol at least once a week (27%), working in a 3-shift system (40.5%) and working overtime (44%). The results show that the police are a group at high risk of developing cardiovascular diseases due to work-related stress.

Study of some biochemical parameters of vitiligo patients in Bangladesh

This study is focus on the biochemical analysis to investigate the condition of different biochemical parameters for the Vitiligo patients. This biochemical analysis deals with the blood serum level of random blood sugar, bilirubin, urea, total protein, SGOT, SGPT, alkaline phosphatase, total cholesterol and uric acids. The increasing some of the biochemical parameters were statistically significant with the age groups. Random blood sugar analysis of the 125 patient's age group 31- 40, 41- 50 and above 50 significantly higher than the control group. No significant changes were observed in serum bilirubin, serum urea, serum creatinine, serum alkaline phosphatase (ALP) and serum asparate amino transferase (AST) level in different age group of Vitiligo patients. In this study, the serum total proteins were slightly decreased in the age group patients below 10 and 11-20 as compared to healthy controls. The average serum total protein level of the below 10 and 11-20 age group patients were 5.31 g/dl and 6.50 g/dl respectively, whereas the controls were 5.95 g/dl and 6.92 g/dl respectively. Serum cholesterol, serum triglycerides and serum uric acid levels were significantly changed in the age group 11-20 and 31-40 compared with the healthy control. The average serum cholesterol level, triglyceride (TG) level and uric acid level were 152.17 mg/dl, 90.27 mg/dl, 4.75 mg/dl and 173.40 mg/dl, 149.95 mg/dl, 5.54 mg/dl respectively for the patients of 11-20 and 31-40 years age group. The controls of these parameters for the 11-20 years and 31-40 years age groups were 150.57 mg/dl, 94.41 mg/dl, 4.28 mg/dl and 156.75 mg/dl, 101mg/dl, 4.77mg/dl respectively. These biochemical studies on Vitiligo indicated that there was no significant changed observed in some biochemical parameters in the different age group of Vitiligo patients but some biochemical parameters like total protein, total cholesterol, triglycerides (TG), uric acid and random blood sugar level were significantly changed in different age group of Vitiligo patients specially among the 11-20 and 31-40 years age group. This biochemical studies would be helpful to know details about the pathological condition of the Vitiligo patients associated with other disease. DOI: http://dx.doi.org/10.3329/bjsir.v47i2.11449 Bangladesh J. Sci. Ind. Res. 47(2), 173-186, 2012

Sensory evaluation and effectiveness of natural drink for lowering blood cholesterol concentrations

The Koreans with the average serum cholesterol value ranged from 200~ 240 mg/dL are quite high, and thus it is a serious medical problem in the society. In this study, natural drink mostly made with medicinal herbs such as Albizzia julibrissin Durazz, Cassia tora L. seed, Maximowiczia chinensis, Morus alba L., and Glycyrrhiza uralensis was developed as anticholesterolemic drink. Sensory evaluation and anticholesterolemic effects of natural herbal drinks were tested. Sensory evaluation was performed by 146 panels (male 79, female 67) on the strength of color, flavor, taste, preference and overall acceptance based on 9 point‐hedonic scale. Anticholesterolemic effect of natural herbal drink was examined for serum lipid fractions by 15 adults at 0, 4, 8 and 12 week after use of one can (140 ml/can) a day. Sensory test results indicated that 6.0 pt was attained for the color, 5.3 pt., 4.1 pt., 5.7 pt. for flavor of Korean herbal medicine, astringent taste, and sweet taste, respectively. Overall acceptance(5.6 pt.) was not so high. However, the blood levels of total lipid, and triglyceride were decreased since after 8 weeks of the consumption and those of total cholesterol and LDL‐cholesterol also decreased significantly. From the findings, our natural herbal drink might be a good functional drink having anticholesterolemic effect. However, the natural herbal drink needs to be improved in the taste, flavor, and overall acceptance.

Hypercholesterolemia and Myocardial function evaluated via Tissue Doppler Imaging

ObjectiveTo establish a link between hypercholesterolemia and myocardial dysfunction.BackgroundHeart failure is a complex disease involving changes in systolic and diastolic function. Newer echocardiographic imaging modalities may be able to detect discreet changes in myocardial function associated with hypercholesterolemia. Therefore we sought to establish a link between hypercholesterolemia and myocardial dysfunction with tissue Doppler imaging (TDI).MethodsTwenty-seven rabbits were studied: 7 were fed normal chow (group 1) and 20 a high cholesterol diet (10 with ezetimibe, 1 mg/kg/day; group 2 and 10 without, group 3). Echocardiographic images were obtained under general anesthesia. Serum cholesterol levels were obtained at baseline, 3 and 6 months and myocardial cholesterol levels measured following euthanasia.ResultsDoppler measurements, including E/A, E'/A' and S' were significantly lower in group 3 compared to both groups 1 and 2 but no significant differences were noted in chamber sizes or ejection fraction among the groups. Average serum cholesterol was higher in group 3 compared to groups 1 and 2 respectively (495 ± 305 mg/dl vs. 114 ± 95 mg/dl and 87 ± 37 mg/dl; p < 0.01). Myocardial cholesterol content was also higher in group 3 compared to group 2 (0.10 ± 0.04 vs. 0.06 mg/dl ± 0.02; p = 0.05). There was significant correlation between S', E'/A', E/E' and serum cholesterol (r2 = 0.17 p = 0.04, r2 = 0.37 p = 0.001 and r2 = 0.24 p = 0.01).ConclusionCholesterol load in the serum and myocardium was significantly associated with decreased systolic and diastolic function by TDI. Moreover, lipid lowering was protective.

Changing trends (1986–2003) in the use of lipid lowering medication in patients hospitalized with acute myocardial infarction: A community-based perspective

ObjectivesThe objectives of this community-wide observational study were to describe nearly two decade long (1986–2003) trends in the use of lipid lowering therapy in patients hospitalized with acute myocardial infarction (AMI) and clinical and demographic factors associated with underutilization of this treatment regimen. MethodsA total of 9429 greater Worcester (MA) residents hospitalized with confirmed AMI at all metropolitan Worcester medical centers in 10 annual periods between 1986 and 2003 comprised the study population. Hospital medical records were reviewed to ascertain the prescribing of lipid lowering agents during hospitalization for AMI. ResultsThe mean age of the study sample was 70 years, 58% were men, and the average total and LDL serum cholesterol levels were 203 and 114 mg/dL, respectively. There was a marked increase in the use of lipid lowering therapy in greater Worcester residents hospitalized with AMI between 1986 (<1%) and 2003 (76%). Increasing use of lipid lowering medication was observed both with regards to the maintenance of this therapy in patients who were already on this treatment regimen and in the new initiation of lipid lowering medication in patients who had not been previously treated with this therapy. Several patient demographic and clinical factors, including advanced age and an initial AMI, were associated with the failure to be prescribed lipid lowering therapy during hospitalization for AMI. ConclusionsThe results of this study suggest encouraging increases over time in the use of lipid lowering therapy in patients hospitalized with AMI. Despite these encouraging trends, several high-risk patient groups remain suboptimally treated.

Hyperlipidemia in Iranian liver transplant recipients: prevalence and risk factors

Hyperlipidemia is a metabolic complication after liver transplantation (LT). The aim of this study was to investigate the prevalence and risk factors for developing hyperlipidemia in patients who underwent LT in the Shiraz Organ Transplantation Center. Our patients were 170 liver recipients who underwent LT from 1994 to 2006 in the Organ Transplantation Center of the Shiraz University of Medical Sciences. To perform this study we administered questionnaires, including information about age, sex, body mass index (BMI), underlying liver disease, graft type, immunosuppressive medications, and serum levels of triglycerides and cholesterol, before and 6 months after LT. Serum triglyceride and cholesterol levels were considered elevated if they were >150 mg/dl and >250 mg/dl, respectively. Data were analyzed with SPSS software. There were 108 male and 62 female patients, with a mean age of 31.4 +/- 13.3 years, and the mean duration of follow-up was 25.9 +/- 23.5 months. The average pretransplant serum triglyceride and cholesterol (mean of individual means) levels were 104.6 +/- 73.2 and 109.5 +/- 51.5 mg/dl, respectively, and the average posttransplant levels were 230.1 +/- 131 and 185 +/- 77 mg/dl, respectively. Six months after LT, 119 (70%) and 26 (15.3%) patients developed hypertriglyceridemia and hypercholesterolemia, respectively. Age, sex, BMI, and underlying liver disease were not predictors of hypertriglyceridemia or hypercholesterolemia (P > 0.05). Posttransplant hypertriglyceridemia was significantly more common in patients receiving tacrolimus than in those receiving cyclosporine (P = 0.040), but posttransplant hypercholesterolemia had no significant correlation with type of immune suppression (P > 0.05). Hyperlipidemia was common after LT, and hypertriglyceridemia was more common than hypercholesterolemia. Among all risk factors, tacrolimus therapy was correlated with development of hypertriglyceridemia after LT.

Role of Berberis lycium in Reducing Serum Cholesterol in Broilers

This study was planned to investigate the role of Berberis lycium in reducing serum cholesterol in broilers. Six experimental rations designated as A, B, C, D, E and F having 0, 0.5, 1.0, 1.5, 2.0 and 2.5% Berberis lycium were fed to 240 broiler chicks, randomly distributed into 24 replicates, so as to have 4 replicates per group and 10 chicks per replicate. The experiment lasted for 35 days. Average serum total cholesterol, triglyceride, high density lipoprotein (HDL) and low density lipoprotein (LDL) were used as criteria of response. Average total serum cholesterol per chick was 129.33, 120.50, 116.50, 113.00, 101.67 and 114.00 mg/dl for group A, B, C, D, E and F respectively. Total serum cholesterol showed decreasing trend with the increasing level of Berberis lycium unto 2% (p<0.05). Mean serum triglyceride level per chick was 60.00, 58.17, 58.00, 55.33, 50.17 and 48.50 mg/dl for group A, B, C, D, E and F respectively. Mean serum triglyceride showed decreasing trend with the increasing level of Berberis lycium (p<0.05). Serum triglyceride was significantly lower in group F than other groups. Mean HDL per chick for the six experimental groups A, B, C, D, E and F was 52.08, 53.42, 60.42, 62.25, 62.92 and 54.50 mg/dl respectively. HDL showed increasing trend with the increase in the level of Berberis lycium unto 2%. The average serum LDL per chick was 65.25, 55.45, 44.48, 39.68, 28.72 and 49.80 mg/dl for group A, B, C, D, E and F respectively. LDL also showed decreasing trend with the increase in the level of Berberis lycium unto 2% (p<0.05). It was concluded that Berberis lycium added to feed at the rate of 2.0% can be used in broiler feed for reducing serum total cholesterol, triglyceride and LDL and increasing HDL.

Long-term trends in major cardiovascular risk factors in cohorts of aging men in the European cohorts of the Seven Countries Study

Time trends in major cardiovascular risk factors are described in cohorts of middle-aged men followed for 35 years in 9 European cohorts of Finland, The Netherlands, Italy, Serbia and Greece. Men aged 40 to 59 years at entry in the early 1960s were repeatedly re-examined 3 to 5 times over the last 35 years. Systolic blood pressure, serum cholesterol, body weight and body mass index were considered for analysis, including study of aging (35 years of follow-up) and of generation effects (10 years for men aged 50-59 in the period 1960-1970 and separately 10 years for men aged 75-84 years in the period 1985-1995). For the aging effect, average systolic blood pressure increased approximately 15 mmHg over 25 years maintaining a steady state thereafter, the largest increases being found in Serbia and Greece. Average serum cholesterol varied between approximately 4.5 in Serbia and 6.5 mmo/L in Finland in about 1960. Twenty-five years later, the average level was about 6 mmol/L in all five countries and decreased slightly thereafter. Average body weight and body mass index increased in all countries for 25 years and levelled off thereafter. For the generation effect, average systolic blood pressure decreased in all countries, with the exception of men aged 50-59 in Serbia and men aged 75-84 in The Netherlands. Average serum cholesterol uniformly increased in men aged 50-59 for the younger age-class and slightly decreased in men aged 75-84. Average body weight and body mass index increased systematically in all countries and in both age groups. Major changes were the great increases in average systolic blood pressure and serum cholesterol level in Serbia and in systolic blood pressure level in Greece between 1960 and 1985, and the large decrease in average serum cholesterol in Finland between 1970 and 1995. Average body weight and body mass index showed universal increases in both middle-aged and older men after 1960.

Association between cholesterol level and mortality in dialysis patients: role of inflammation and malnutrition.

Total cholesterol level is inversely associated with mortality in dialysis patients, a group at high risk of cardiovascular disease (CVD). This paradox may be explained by systemic inflammation and/or malnutrition, which are associated with lower cholesterol levels and higher mortality. To determine the relationship between cholesterol level and outcome in patients undergoing dialysis, accounting for inflammation and malnutrition. Prospective study of 823 patients enrolled from October 1995 to June 1998 who recently initiated dialysis, from 79 clinics, classified by absence or presence of inflammation and/or malnutrition (defined as serum albumin levels <3.6 mg/dL, C-reactive protein > or =10 mg/L, or interleukin 6 > or =3.09 pg/mL). All-cause and cardiovascular disease mortality. During a median follow-up of 2.4 years, 324 deaths (159 CVD deaths), 153 renal transplantations, and 10 losses to follow-up occurred. Average serum cholesterol level was lower in the presence of inflammation/malnutrition than in its absence. In a Cox model adjusted for age, race, and sex, a 40-mg/dL (1.0-mmol/L) increment in baseline total serum cholesterol level was associated with a decreased risk of all-cause mortality overall (relative hazard [RH], 0.92; 95% confidence interval [CI], 0.87-0.98) and in the presence of inflammation/malnutrition (RH, 0.89; CI, 0.84-0.95). In contrast, serum cholesterol level was associated with an increased risk in the absence of inflammation/malnutrition (RH, 1.32; 95% CI, 1.07-1.63). For CVD mortality, an inverse trend was not statistically significant in the presence of inflammation/malnutrition, and a positive association was evident in the absence of inflammation/malnutrition (RH, 1.41; 95% CI, 1.04-1.89). Further adjustment for traditional CVD risk factors, dialysis modality, comorbidity, and inflammatory markers attenuated the inverse association but strengthened the positive association. The inverse association of total cholesterol level with mortality in dialysis patients is likely due to the cholesterol-lowering effect of systemic inflammation and malnutrition, not to a protective effect of high cholesterol concentrations. These findings support treatment of hypercholesterolemia in this population.