title: Long-term prognostic importance of total cholesterol in elderly survivors of an acute myocardial infarction: the Cooperative Cardiovascular Pilot Project.
abstract: OBJECTIVE
  To determine the long-term prognostic importance of in-hospital total serum cholesterol in elderly survivors of acute myocardial infarction (AMI).
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  Acute care, nongovernmental hospitals in Alabama, Connecticut, Iowa, and Wisconsin.
  
  
  METHODS
  Four thousand nine hundred twenty-three Medicare beneficiaries from four states aged 65 and older discharged alive with a principal diagnosis of AMI between June 1, 1992, and February 28, 1993, who had a measurement of total serum cholesterol during hospitalization.
  
  
  METHODS
  Primary endpoint of all-cause mortality within 6 years of discharge.
  
  
  RESULTS
  Of the 7,166 hospitalizations meeting study inclusion criteria, 4,923 (68.7%) had total cholesterol assessed, and 22% had a cholesterol level of 240 mg/dL or greater. Of AMI hospitalization survivors with cholesterol of 240 md/dL or greater, 17.2% died within 1 year and 47.9% died within 6 years, compared with 17.4% (P =.73) and 48.7% (P =.98) of those with a cholesterol level less than 240 mg/dL. The adjusted hazard ratio for elevated total serum cholesterol measured during hospitalization for all-cause mortality in the 6 years after discharge was 0.97 (95% confidence interval (CI) = 0.87-1.09). The unadjusted 1- and 6-year mortality rates for those with total cholesterol less than 160 mg/dL were 22.2% and 55.5%, respectively, not significantly different from mortality for patients with cholesterol of 160 mg/dL or greater, even after adjustment.
  
  
  CONCLUSIONS
  Among elderly survivors of AMI, elevated total serum cholesterol measured postinfarction is not associated with an increased risk of all-cause mortality in the 6 years after discharge. Furthermore, this study found no evidence of an increased risk of all-cause mortality in patients with low total cholesterol. Further studies are needed to determine the relationship of postinfarction lipid subfractions and mortality in older patients with coronary artery disease (CAD).
authors.affiliation: Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: JoAnne Micale
authors.initials: JM
authors.lastname: Foody
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.forename: Catarina I
authors.initials: CI
authors.lastname: Kiefe
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
authors.forename: Jay
authors.initials: J
authors.lastname: Gold
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Radford
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002784:Cholesterol / Q000097:blood*; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D002784:Cholesterol