title: Risk of hypercholesterolemia for cardiovascular disease and the population attributable fraction in a 24-year Japanese cohort study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Preventive Medicine and Public Health, Keio University School of Medicine.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sugiyama
authors.forename: Tomonori
authors.initials: T
authors.lastname: Okamura
authors.forename: Makoto
authors.initials: M
authors.lastname: Watanabe
authors.forename: Aya
authors.initials: A
authors.lastname: Higashiyama
authors.forename: Nagako
authors.initials: N
authors.lastname: Okuda
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hozawa
authors.forename: Yoshikuni
authors.initials: Y
authors.lastname: Kita
authors.forename: Aya
authors.initials: A
authors.lastname: Kadota
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Murakami
authors.forename: Naomi
authors.initials: N
authors.lastname: Miyamatsu
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Takehito
authors.initials: T
authors.lastname: Hayakawa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyamoto
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miura
authors.forename: Akira
authors.initials: A
authors.lastname: Okayama
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ueshima
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D002784:Cholesterol / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D002784:Cholesterol