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

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.