This Article Full Text Full Text (PDF) All Versions of this Article: 43/5/983    most recent 01.HYP.0000124918.30897.55v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cohen, H. W. Articles by Alderman, M. H. Search for Related Content PubMed PubMed Citation Articles by Cohen, H. W. Articles by Alderman, M. H. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB CHOLESTEROL Medline Plus Health Information High Blood Pressure Related Collections Lipids Risk Factors Glucose intolerance Chronic ischemic heart disease

(Hypertension. 2004;43:983.)
© 2004 American Heart Association, Inc.

Scientific Contributions

Glucose-Cholesterol Interaction Magnifies Coronary Heart Disease Risk for Hypertensive Patients

From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.

Correspondence to Hillel W. Cohen, DrPH, Assistant Professor, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461. E-mail hicohen{at}aecom.yu.edu

Elevated cholesterol and glucose are known independent risk factors for coronary heart disease. This study examines whether an adverse synergistic interaction of cholesterol and glucose magnifies coronary heart disease risk among treated hypertensive patients. Subjects were hypertensive patients (n=6672) in a worksite treatment program, with entry fasting glucose <6.99 mmol/L (126 mg/dL) and total cholesterol <6.72 mmol/L (260 mg/dL) observed for mean 5.6±4.5 years follow-up (range 0.5 to 21.7 years). Outcome events were incident hospitalization or death due to coronary heart disease. Cox proportional hazard models were constructed for the whole sample to assess interaction and then stratified by fasting glucose categories with thresholds defined either at impaired fasting glucose (6.11 mmol/L [110 mg/dL]) or upper quartile (5.72 mmol/L [103 mg/dL]). An interaction product term of total cholesterol and fasting glucose as continuous variables significantly (P=0.009) improved a Cox proportional hazards model, adjusting for total cholesterol, fasting glucose, and other coronary heart disease risk factors. Adjusted hazard ratios for 3 upper total cholesterol categories (with total cholesterol <5.17mmol/L [200 mg/dL] as reference) in the higher fasting glucose stratum were more than double the corresponding hazard ratios in the lower stratum, whether using impaired fasting glucose or upper quartile fasting glucose as the cut point. These results suggest that an adverse synergistic interaction between glucose and cholesterol magnifies coronary heart disease risk associated with total cholesterol among hypertensive patients, raising the possibility that coronary heart disease prevention might be enhanced if cholesterol intervention criteria were modified by glucose status.

Key Words: coronary disease • risk factors • hypercholesterolemia • glucose • hypertension

This article has been cited by other articles:

				M. Helfand, D. I. Buckley, M. Freeman, R. Fu, K. Rogers, C. Fleming, and L. L. Humphrey Emerging Risk Factors for Coronary Heart Disease: A Summary of Systematic Reviews Conducted for the U.S. Preventive Services Task Force Ann Intern Med, October 6, 2009; 151(7): 496 - 507. [Abstract] [Full Text] [PDF]