Is the use of cholesterol in mortality risk algorithms in

clinical guidelines valid? Ten years prospective data from

the Norwegian HUNT 2 study

Abstract

Rationale, aims and objectives

Many clinical guidelines for cardiovascular disease

(CVD) prevention contain risk estimation charts/calculators. These have shown a tendency

to overestimate risk, which indicates that there might be theoretical flaws in the algorithms.

Total cholesterol is a frequently used variable in the risk estimates. Some studies indicate

that the predictive properties of cholesterol might not be as straightforward as widely

assumed. Our aim was to document the strength and validity of total cholesterol as a risk

factor for mortality in a well-defined, general Norwegian population without known CVD

at baseline.

Conclusion

Our study provides an updated epidemiological indication of possible errors

in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable,

clinical and public health recommendations regarding the ‘dangers’ of cholesterol should

be revised. This is especially true for women, for whom moderately elevated cholesterol

(by current standards) may prove to be not only harmless but even beneficial.We assessed the association of


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http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2753.2011.01767.x/pdf