Our population was selected from elderly individuals with a history of various cardiovascular diseases. However, they were all home-dwelling at baseline. With the selection, it is quite possible that many individuals with the metabolic syndrome or diabetes and low cholesterol absorption (and high synthesis) have died earlier in life. Our elderly population would thus represent survivors who are resistant to the deleterious effects of diabetes. Only long-term follow-up studies starting from mid-life or earlier would settle this issue. One-half of the population also participated in an intervention study whereupon their medications and risk factors were treated with usual clinical methods. This improved blood pressure and serum LDL cholesterol level in the intervention group and made the cardiovascular drug treatments more evidence-based (18). However, the intervention did not affect clinical end points (19), and , in accordance with this separate analyses of the intervention and control groups, did not change the present conclusions. All primary clinical end points and deaths were reliably collected and adjudicated. Cholesterol metabolism was assessed indirectly using plasma markers (noncholesterol sterols), but this approach has been assessed suitable for epidemiologic studies (15) |