A single cholesterol measurement underestimates the risk of coronary heart disease. An empirical example from the Lipid Research Clinics Mortality Follow-up Study
C. E. Davis, B. M. Rifkind, H. Brenner and D. J. Gordon
Department of Biostatistics, University of North Carolina, Chapel Hill 27514.
In prospective epidemiologic studies of coronary heart disease, a single
measurement of cholesterol is made to assess its relationship to the risk
of coronary disease. Statistical theory states that if this measurement is
subject to within-individual variability, the strength of the relationship
will be underestimated. This is empirically shown for the example of plasma
cholesterol. For the Lipid Research Clinics Follow-up Study population
(comprising 2170 white men over 30 years of age), the age-adjusted coronary
heart disease mortality regression coefficient increases from .453 to .496
if the average of two cholesterol measurements is used instead of a single
measurement. Since the correlation between the two repeated cholesterol
measurements is .815, an increase in the regression coefficient up to .556
would be expected if the true cholesterol values were available. Thus,
epidemiologic studies have substantially underestimated the strength of the
relationship between cholesterol levels and the risk of coronary disease by
calculating the relationship on the basis of a single cholesterol
determination.
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