142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Higher Rates of Cardiovascular Disease Mortality Associated with Normal Cholesterol Values and Poor Nutritional Behaviors

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Sunday, November 16, 2014

Rodney G. Bowden, PhD , School of Education, Baylor University, Waco, TX
Ronald Wilson, MD , Central Texas Nephrology Associates
Stuart Hebert, MD , University of North Carolina School of Medicine
Introduction: High cholesterol values are associated with cardiovascular disease (CVD), yet counterintuitive findings have occurred with End-Stage-Renal Disease (ESRD) patients.  These paradoxical findings have been called reverse epidemiology where normal cholesterol values are associated with higher mortality.  The purpose of this study was to determine if reverse epidemiological associations exist between cholesterol levels, dietary behavior and mortality Methods: Patients (N=438) were recruited from four dialysis units and tracked for 36 months until study completion or death.  Patients (N=438) were placed into dietary behavior groups based on dietary protein intake. Results: ANCOVA revealed differences at posttest and reverse epidemiological effects for total cholesterol (p=.0001), LDL (p=.023), LDL particle number (p=.0001), LDL size (p=.009), triglycerides (p=.0001), and VLDL (p=.036). A step-wise linear regression revealed weak predictors of mortality with total cholesterol (Beta=.263, p=.017) and LDL (Beta= -.177, p=.045).  Finally, a Cox death hazard ratio revealed LDL size as a significant predictor of mortality.  Conclusions: A reverse epidemiological effect for cholesterol variables was discovered.  Reasons for this counterintuitive finding may a malnutrition-inflammation complex.  Higher death rates from CVD in ESRD patients with normal cholesterol levels have been reported in previous studies, yet this relationship was not reported when patients had normal inflammation and albumin levels.  Few studies have been conducted with even fewer database studies. Identification of patients with normal cholesterol levels but high levels of inflammatory cytokines and poor nutritional behaviors may help to better control CVD mortality.  Elevated levels of cholesterol have been reported to be a good predictor of survival in other populations as well including chronic heart failure, chronic respiratory failure, HIV, cancer and rheumatoid arthritis.

Learning Areas:

Chronic disease management and prevention

Learning Objectives:
Describe the term Reverse Epidemiology Compare the differences in cholesterol and inflammation levels on health outcomes Name the factors associated with normal cholesterol levels and increased morbidity and mortality

Keyword(s): Behavioral Research, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-principal investigator of federally funded grants, peer-reviewed publications and presentations focusing on the epidemiology of chronic diseases. Among my scientific interests has been the assessment of novel risk factors to help in the prevention of cardiovascular disease
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.