한동희 (Cedars-Sinai Medical Center)

한빛사논문

조회270

Cedars-Sinai Medical Center

CV File 216 kb

Prog. Cardiovasc. Dis., 20 October 2022;S0033-0620(22)00106-2 | https://doi.org/10.1016/j.pcad.2022.10.007 Association between hypercholesterolemia and mortality risk among patients referred for cardiac imaging test: Evidence of a “cholesterol paradox?”

Alan Rozanski^a,1, Donghee Han^b,1, Michael J. Blaha^c, Heidi Gransar^b, John Friedman^b, Sean Hayes^b, Louise E.J. Thomson^b, Michael D. Miedema^d, Khurram Nasir^e, Matthew J. Budoff^f, Leslee J. Shaw^g, John A. Rumberger^h, Roger S. Blumenthal^c, Todd Villinesⁱ, Fay Lin^j, Daniel S. Berman^b

^aDivision of Cardiology, Mount Sinai Morningside Hospital, NY, New York, United States of America
^bDepartment of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
^cJohns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, United States of America
^dMinneapolis Heart Institute and Foundation, Minneapolis, MN, United States of America
^eDivision Cardiovascular Prevention and Wellness, Houston Methodist Hospital, Houston, TX, United States of America
^fDepartment of Medicine, Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, California, United States of America
^gBlatvatnik Family Women's Health Research Institute, Mount Sinai Hospital, New York, NY, United States of America
^hPrinceton Longevity Center, Princeton Forrestal Village, Princeton, NJ, United States of America
ⁱDepartment of Cardiovascular Disease, University of Virginia, Charlottesville, VA, United States of America
^jDepartment of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, United States of America

1Contributed equally.
Corresponding author: Alan Rozanski

Abstract

Aim: Some observational studies have observed a lower, rather than higher, mortality rate in association with hypercholesterolemia during follow-up of patients after cardiac stress testing. We aim to assess the relationship of hypercholesterolemia and other CAD risk factors to mortality across a wide spectrum of patients referred for various cardiac tests.

Methods and results: We identified four cardiac cohorts: 64,357 patients undergoing coronary artery calcium (CAC) scanning, 10,814 patients undergoing coronary CT angiography (CCTA), 31,411 patients without known CAD undergoing stress/rest single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and 5051 patients with known CAD undergoing stress/rest SPECT-MPI. Each cohort was followed for all-cause mortality using risk-adjusted Cox models. We pooled the hazard ratios between cohorts with a random effects model. Baseline risk varied markedly among cohorts, from an annualized mortality rate of 0.31%/year in CAC patients to 3.63%/year among SPECT-MPI patients with known CAD. Hypertension, diabetes, and smoking were each associated with increased mortality in each patient cohort (pooled hazard ratio[95% CI]: 1.38[1.33-1.44], 1.88[1.76-2.00], and 1.67[1.48-1.86], respectively). By contrast, hypercholesterolemia was associated with decreased rather than increased mortality (pooled hazard ratio[95% CI]: 0.71[0.58-0.84]). Analysis of serum lipids among 7744 patients undergoing CAC or CCTA scanning revealed an inverse relationship between LDL cholesterol and mortality.

Conclusions: Among a broad spectrum of patients referred for a variety of cardiac tests and ranging from low to high clinical risk, hypercholesterolemia was not associated with increased mortality risk. Our findings suggest that hypercholesterolemia may be sensitive to confounding by other clinical factors and post-test treatment changes in patient populations.

논문정보

형식Research article
게재일2022년 10월 (BRIC 등록일 2023-01-05)
연구진국외 연구진
분야 의약학 > 응용의학

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