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Dutch Lipid Clinic Network low-density lipoprotein cholesterol criteria are associated with long-term mortality in the general population.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Séguro, Florent Bongard, Vanina Bérard, Emilie Taraszkiewicz, Dorota Ruidavets, Jean-Bernard Ferrières, Jean
Spatial Coverage	France
Description	Country affiliation: France Author Affiliation: Séguro F ( Fédération de cardiologie, TSA 50032, CHU de Rangueil, 31059 Toulouse cedex 9, France.); Bongard V ( Département d'épidémiologie, économie de la santé et santé publique, UMR1027 Inserm, université Toulouse III, 31073 Toulouse, France); Bérard E ( Département d'épidémiologie, économie de la santé et santé publique, UMR1027 Inserm, université Toulouse III, 31073 Toulouse, France); Taraszkiewicz D ( Fédération de cardiologie, TSA 50032, CHU de Rangueil, 31059 Toulouse cedex 9, France.); Ruidavets JB ( Département d'épidémiologie, économie de la santé et santé publique, UMR1027 Inserm, université Toulouse III, 31073 Toulouse, France); Ferrières J ( Fédération de cardiologie, TSA 50032, CHU de Rangueil, 31059 Toulouse cedex 9, France)
Abstract	BACKGROUND: Heterozygous familial hypercholesterolaemia (HeFH) is a severe autosomal dominant disease that is underdiagnosed, inadequately treated and has a severe long-term cardiovascular risk. Few studies have evaluated the long-term risk of high low-density lipoprotein cholesterol (LDL-C) concentrations. AIM: To evaluate long-term mortality in a large cohort of healthy subjects, according to LDL-C concentrations. METHODS: Based on a sample of 6956 subjects visiting a preventive cardiology department, we selected adult subjects without a personal history of cardiovascular disease. From 1995 to 2011, 4930 healthy subjects were examined and followed up until 31 December 2011. All-cause deaths were collected exhaustively. A Cox-based multivariable analysis evaluated long-term total mortality risk according to Dutch Lipid Clinic Network (DLCN) LDL-C concentrations. RESULTS: After a mean follow-up of 8.6 years, 123 all-cause deaths were recorded (cumulative mortality rate, 2.5%). In the final multivariable model, major risk factors such as age, sex, tobacco use and diabetes were significantly associated with mortality. After adjustment for age, sex, tobacco use, hypertension, diabetes and statin therapy, and in comparison with subjects with LDL-C<4 mmol/L (<155 mg/dL), subjects with LDL-C between 4 and <5 mmol/L (155 to <190 mg/dL) had a hazard ratio (HR) of 1.99 (95% confidence interval [CI] 1.31-3.02; P=0.001), subjects with LDL-C between 5 and <6.5 mmol/L (190 to <250 mg/dL) had an HR of 1.81 (95% CI, 1.06-3.02; P=0.030), subjects with LDL-C between 6.5 and<8.5 mmol/L (250 to <330 mg/dL) had an HR of 2.69 (95% CI, 1.06-6.88; P=0.038) and subjects with LDL-C ≥ 8.5 mmol/L (≥330 mg/dL) had an HR of 6.27 (95% CI, 0.84-46.57; P=0.073). After excluding patients on statins at baseline, subjects with LDL-C ≥ 8.5 mmol/L (≥330 mg/dL) had an HR of 8.17 (95% CI, 1.08-62.73; P=0.042). CONCLUSIONS: The severity of LDL-C elevation is associated with a higher risk of death in healthy subjects. DLCN LDL-C concentrations may be used in daily practice to identify patients with HeFH who warrant aggressive treatment.
File Format	HTM / HTML
ISSN	18752136
Issue Number	10
Volume Number	108
e-ISSN	18752128
Journal	Archives of Cardiovascular Diseases
Language	English
Publisher	Elsevier
Publisher Date	2015-10-01
Publisher Place	Netherlands
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Cardiology Cholesterol, Ldl Blood Hyperlipoproteinemia Type Ii Mortality Adult Aged Biological Markers Chi-square Distribution Female France Epidemiology Genetic Predisposition To Disease Heterozygote Humans Diagnosis Genetics Therapy Male Middle Aged Multivariate Analysis Phenotype Predictive Value Of Tests Prognosis Proportional Hazards Models Prospective Studies Risk Assessment Risk Factors Severity Of Illness Index Time Factors Up-regulation Journal Article
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine

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