Association of serum total cholesterol with coronary disease and all-cause mortality: multivariate correction for bias due to measurement error

American Journal of Epidemiology
C IribarrenJ H Dwyer

Abstract

Measurement error in the exposure under investigation is an important but often ignored source of bias in observational studies. The authors examined the impact of measurement error in the association between total serum cholesterol and 16-year coronary heart disease and all-cause mortality in a cohort of 6,137 middle-aged men of Japanese descent in the Honolulu Heart Program (1973-1988). A Cox regression model that enables modeling of survival time with correction for measurement errors in multiple covariates was employed. After controlling for age, body mass index, systolic blood pressure, smoking status, alcohol consumption, dietary cholesterol, and total calorie intake, a difference of one standard deviation (38 mg/dL) in total cholesterol was associated with a significant increase in the risk of coronary disease death (uncorrected hazard ratio = 1.35). After correction for measurement errors in total cholesterol and covariates (except smoking and age), the estimated hazard ratio increased to 1.65 (a 22% increase). A U-shaped relation was observed between total cholesterol levels and the risk of all-cause mortality. This association was then examined with a quadratic model and with a two-slope or V-shaped regression model. ...Continue Reading

Associated Clinical Trials

Citations

Feb 18, 1998·Annals of Epidemiology·M W KnuimanP E Fitzgerald
Jan 28, 2005·Journal of the American Geriatrics Society·Nicole SchupfRichard Mayeux
Jun 29, 2012·Dose-response : a Publication of International Hormesis Society·Louis Anthony Tony Cox
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Apr 13, 2006·Journal of Toxicology and Environmental Health. Part a·Iris M HeidH-Erich Wichmann
Jun 10, 2004·European Journal of Cardiovascular Prevention and Rehabilitation : Official Journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology·Jonathan R EmbersonAnn Rumley

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