title: Cholesterol and glucose metabolism and recurrent cardiovascular events among the elderly: a prospective study.
abstract: OBJECTIVE
  The aim of this research was to evaluate the prognostic value of cholesterol absorption assessed with the serum cholestanol-to-cholesterol concentration ratio (lower level reflects decreased cholesterol absorption) among elderly cardiovascular patients (DEBATE [Drugs and Evidence-Based Medicine in the Elderly] study).
  
  
  BACKGROUND
  The components of the metabolic syndrome have been unexpectedly associated with better prognosis among elderly cardiovascular patients. On the other hand, a metabolic syndrome-type state is characterized by high synthesis and decreased absorption of cholesterol.
  
  
  METHODS
  This was a prospective cohort study of home-dwelling individuals age 75 years and older with cardiovascular diseases (247 women, 129 men) recruited from the community. Main outcome measure was multivariate-adjusted time to 3.4-year mortality and recurrent major cardiovascular events.
  
  
  RESULTS
  Serum total and low-density lipoprotein cholesterol levels did not predict outcome. Instead, the mortality risk (64 deaths) increased with increasing levels of cholestanol-to-cholesterol ratio. Patients in the 2nd, 3rd, and 4th quartiles had a relative hazard ratio (HR) for death of 2.54 (95% confidence interval [CI] 1.05 to 6.12), 2.48 (95% CI 1.03 to 6.00), and 3.53 (95% CI 1.52 to 8.19) compared with the lowest quartile, even though 50% of individuals in the lowest cholestanol quartile had metabolic syndrome or diabetes. In multivariate models, the lowest cholestanol ratio quartile was independently associated with lower mortality (relative HR, 0.37, 95% CI 0.17 to 0.81), and with fewer major cardiovascular events (115 events, relative HR, 0.59, 95% CI 0.35 to 0.98).
  
  
  CONCLUSIONS
  Low cholesterol absorption was associated with fewer recurrent cardiovascular events, and with better survival in elderly patients despite frequent abnormalities of glucose metabolism.
authors.affiliation: Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland. timo.strandberg@oulu.fi
authors.forename: Timo E
authors.initials: TE
authors.lastname: Strandberg
authors.forename: Reijo S
authors.initials: RS
authors.lastname: Tilvis
authors.forename: Kaisu H
authors.initials: KH
authors.lastname: Pitkala
authors.forename: Tatu A
authors.initials: TA
authors.lastname: Miettinen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000209:etiology*; D002784:Cholesterol / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D015999:Multivariate Analysis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D001786:Blood Glucose; D002784:Cholesterol