scholarly journals Association between cholesterol intake and all-cause mortality: NHANES-linked mortality study

2021 ◽  
Vol 29 (2) ◽  
pp. 117-121
Author(s):  
Xiangpeng Du ◽  
Hui Xin
Keyword(s):  
Mortality Study ◽  
All Cause Mortality ◽  
Cholesterol Intake

scholarly journals Dietary cholesterol and egg intake in relation to incident cardiovascular disease and all-cause and cause-specific mortality in postmenopausal women

2020 ◽  
Author(s):  
Guo-Chong Chen ◽  
Li-Hua Chen ◽  
Yasmin Mossavar-Rahmani ◽  
Victor Kamensky ◽  
Aladdin H Shadyab ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Postmenopausal Women ◽  
Dietary Cholesterol ◽  
Saturated Fat ◽  
Inverse Association ◽  
Egg Consumption ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cholesterol Intake ◽  
Incident Cardiovascular Disease

ABSTRACT Background The potential cardiovascular impact of dietary cholesterol intake has been actively debated for decades. Objectives We aimed to evaluate associations of dietary cholesterol and egg intakes with incident cardiovascular disease (CVD) and all-cause and cause-specific mortality. Methods We included 96,831 US postmenopausal women aged 50–79 y without known CVD or cancer during baseline enrollment (1993–1998) of the Women's Health Initiative. Dietary information was collected using a validated FFQ. Incident CVD [i.e., ischemic heart disease (IHD) and stroke] and all-cause and cause-specific mortality were ascertained and adjudicated through February 2018. Results A total of 9808 incident CVD cases and 19,508 all-cause deaths occurred during a median follow-up of 17.8 y and 18.9 y, respectively. After multivariable adjustment for traditional risk factors and key dietary nutrients including dietary saturated fat, there were modest associations of dietary cholesterol intake with incident CVD (HRQ5versusQ1: 1.12; 95% CI: 1.03, 1.21; P-trend < 0.001) and all-cause mortality (HRQ5versusQ1: 1.09; 95% CI: 1.02, 1.15; P-trend < 0.001). Significant positive associations were also observed between dietary cholesterol and incident IHD (P-trend = 0.007), incident ischemic stroke (P-trend = 0.002), and CVD mortality (P-trend = 0.002), whereas there was an inverse association for incident hemorrhagic stroke (P-trend = 0.037) and no association for mortality from cancer, Alzheimer disease/dementia, respiratory diseases, or other causes (P-trend > 0.05). Higher egg consumption was also associated with modestly higher risk of incident CVD (P-trend = 0.004) and all-cause mortality (P-trend < 0.001), with HRs of 1.14 (95% CI: 1.04, 1.25) and 1.14 (95% CI: 1.07, 1.22), respectively, when comparing ≥1 egg/d with <1 egg/wk. Conclusions Both higher dietary cholesterol intake and higher egg consumption appeared to be associated with modestly elevated risk of incident CVD and all-cause mortality in US postmenopausal women.

scholarly journals Egg and cholesterol consumption and mortality from cardiovascular and different causes in the United States: A population-based cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (2) ◽  
pp. e1003508
Author(s):  
Pan Zhuang ◽  
Fei Wu ◽  
Lei Mao ◽  
Fanghuan Zhu ◽  
Yiju Zhang ◽  
...  
Keyword(s):  
Respiratory Disease ◽  
Cancer Mortality ◽  
Cardiovascular Health ◽  
The United States ◽  
Self Report ◽  
Term Survival ◽  
Egg Consumption ◽  
All Cause Mortality ◽  
Cholesterol Intake ◽  
Whole Egg

Background Whether consumption of egg and cholesterol is detrimental to cardiovascular health and longevity is highly debated. Data from large-scale cohort studies are scarce. This study aimed to examine the associations of egg and cholesterol intakes with mortality from all causes, cardiovascular disease (CVD), and other causes in a US population. Methods and findings Overall, 521,120 participants (aged 50–71 years, mean age = 62.2 years, 41.2% women, and 91.8% non-Hispanic white) were recruited from 6 states and 2 additional cities in the US between 1995 and 1996 and prospectively followed up until the end of 2011. Intakes of whole eggs, egg whites/substitutes, and cholesterol were assessed by a validated food frequency questionnaire. Cause-specific hazard models considering competing risks were used, with the lowest quintile of energy-adjusted intake (per 2,000 kcal per day) as the reference. There were 129,328 deaths including 38,747 deaths from CVD during a median follow-up of 16 years. Whole egg and cholesterol intakes were both positively associated with all-cause, CVD, and cancer mortality. In multivariable-adjusted models, the hazard ratios (95% confidence intervals) associated with each intake of an additional half of a whole egg per day were 1.07 (1.06–1.08) for all-cause mortality, 1.07 (1.06–1.09) for CVD mortality, and 1.07 (1.06–1.09) for cancer mortality. Each intake of an additional 300 mg of dietary cholesterol per day was associated with 19%, 16%, and 24% higher all-cause, CVD, and cancer mortality, respectively. Mediation models estimated that cholesterol intake contributed to 63.2% (95% CI 49.6%–75.0%), 62.3% (95% CI 39.5%–80.7%), and 49.6% (95% CI 31.9%–67.4%) of all-cause, CVD, and cancer mortality associated with whole egg consumption, respectively. Egg white/substitute consumers had lower all-cause mortality and mortality from stroke, cancer, respiratory disease, and Alzheimer disease compared with non-consumers. Hypothetically, replacing half a whole egg with equivalent amounts of egg whites/substitutes, poultry, fish, dairy products, or nuts/legumes was related to lower all-cause, CVD, cancer, and respiratory disease mortality. Study limitations include its observational nature, reliance on participant self-report, and residual confounding despite extensive adjustment for acknowledged dietary and lifestyle risk factors. Conclusions In this study, intakes of eggs and cholesterol were associated with higher all-cause, CVD, and cancer mortality. The increased mortality associated with egg consumption was largely influenced by cholesterol intake. Our findings suggest limiting cholesterol intake and replacing whole eggs with egg whites/substitutes or other alternative protein sources for facilitating cardiovascular health and long-term survival. Trial registration ClinicalTrials.gov NCT00340015.

scholarly journals Estimation of Mortality Risk in Type 2 Diabetic Patients (ENFORCE): An Inexpensive and Parsimonious Prediction Model

2019 ◽  
Vol 104 (10) ◽  
pp. 4900-4908 ◽  
Author(s):  
Massimiliano Copetti ◽  
Hetal Shah ◽  
Andrea Fontana ◽  
Maria Giovanna Scarale ◽  
Claudia Menzaghi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Trial ◽  
Real Life ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Mortality Study ◽  
C Statistic ◽  
All Cause Mortality ◽  
Type 2 Diabetic

AbstractContextWe previously developed and validated an inexpensive and parsimonious prediction model of 2-year all-cause mortality in real-life patients with type 2 diabetes.ObjectiveThis model, now named ENFORCE (EstimatioN oF mORtality risk in type 2 diabetiC patiEnts), was investigated in terms of (i) prediction performance at 6 years, a more clinically useful time-horizon; (ii) further validation in an independent sample; and (iii) performance comparison in a real-life vs a clinical trial setting.DesignObservational prospective randomized clinical trial.SettingWhite patients with type 2 diabetes.PatientsGargano Mortality Study (GMS; n = 1019), Foggia Mortality Study (FMS; n = 1045), and Pisa Mortality Study (PMS; n = 972) as real-life samples and the standard glycemic arm of the ACCORD (Action to Control Cardiovascular Risk in Diabetes) clinical trial (n = 3150).Main Outcome MeasureThe endpoint was all-cause mortality. Prediction accuracy and calibration were estimated to assess the model's performances.ResultsENFORCE yielded 6-year mortality C-statistics of 0.79, 0.78, and 0.75 in GMS, FMS, and PMS, respectively (P heterogeneity = 0.71). Pooling the three cohorts showed a 6-year mortality C-statistic of 0.80. In the ACCORD trial, ENFORCE achieved a C-statistic of 0.68, a value significantly lower than that obtained in the pooled real-life samples (P < 0.0001). This difference resembles that observed with other models comparing real-life vs clinical trial settings, thus suggesting it is a true, replicable phenomenon.ConclusionsThe time horizon of ENFORCE has been extended to 6 years and validated in three independent samples. ENFORCE is a free and user-friendly risk calculator of all-cause mortality in white patients with type 2 diabetes from a real-life setting.

Abstract P508: Association of Egg and Dietary Cholesterol Intake With Incident Cardiovascular Disease and All-cause Mortality

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Guochong Chen ◽  
Li-Hua Chen ◽  
Yasmin Mossavar-Rahmani ◽  
Victor Kamensky ◽  
Aladdin Shadyab ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Dietary Cholesterol ◽  
Cox Proportional Hazards ◽  
Blood Cholesterol ◽  
Processed Meat ◽  
Food Groups ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Cholesterol Intake ◽  
Overall Mortality

Introduction: The association of egg or dietary cholesterol intake with risk of cardiovascular disease (CVD) and overall mortality remains a topic of active debate. Hypothesis: Higher egg or dietary cholesterol intake is associated with elevated risk of CVD and all-cause mortality. Methods: We analyzed data from 96,755 women aged 50-79 years who were free of CVD and cancer at baseline (1993-1998)(Women’s Health Initiative). Baseline dietary data were collected using a validated food frequency questionnaire. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals of CVD or mortality ascertained through February, 2018. Results: After multivariable adjustment (model 1 in Figure ), higher intakes of egg and dietary cholesterol both were associated with increased risk of CVD (HRs: 1.09 [1.06-1.13] for ½ eggs/day and 1.13 [1.09-1.17] for cholesterol intake of 100 mg/1000 Kcal/day) and all-cause mortality (HRs: 1.10 [1.07-1.12] for egg and 1.16 [1.12-1.19] for cholesterol intake). These associations persisted with further adjustment for other major food groups (e.g. red/processed meat) or nutrients (e.g. saturated fat), or for several potential intermediators (model 2 in Figure ). For both egg and cholesterol intakes, the positive associations with CVD were limited to obese individuals and the associations with all-cause mortality were more pronounced in individuals with diabetes (all P -interaction≤0.002). Among 9451 participants with blood cholesterol measurements, egg or cholesterol intake remained associated with increased CVD and mortality, and the associations were not altered by further adjustment for LDL and HDL cholesterol despite the expected associations of both lipid measures with CVD and mortality ( Figure ). Conclusions: A higher intake of eggs or dietary cholesterol was associated with higher risk of CVD in obese women and overall mortality predominantly in women diagnosed with diabetes. These associations appeared not attributable to blood cholesterol.

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