ArticlesTotal cholesterol and risk of mortality in the oldest old
Introduction
The importance of hypercholesterolaemia as a risk factor for cardiovascular disease in middle-aged people suggests that cholesterol-lowering therapy should be used to prevent morbidity and mortality. Above age 70 years, the significance of hypercholesterolaemia as a cardiovascular risk factor is controversial. The results of observational studies are conflicting, and data from controlled clinical trials on the effect of cholesterol lowering in the elderly are rare. Even if mechanisms of cardiovascular disease are the same for middle-aged and older people, the greater comorbidity and poorer health status in the elderly—as well as the cumulative years of risk exposure—hamper the generalisation of epidemiological results from younger to older individuals. Whether or not hypercholesterolaemia in elderly people with cardiovascular disease should be treated is therefore contested.
The finding that low cholesterol concentrations may be associated with increased mortality risk from cancer, respiratory disease, and trauma,1 had also caused discussion. Some outcomes of clinical-intervention trials with cholesterol-lowering drugs suggest a similar increased mortality risk among the members of the actively treated group.2, 3 To explore further the relation between cholesterol as a risk factor for cardiovascular disease in the elderly, we assessed the effects of total cholesterol concentrations on specific and all-cause mortality in the Leiden 85-plus study.
Section snippets
Leiden 85-plus study
On Dec 1, 1986, the community of Leiden in the Netherlands had 105 000 inhabitants, of whom 1258 (1·2%) were 85 years and older. Among these oldest old, we initiated a population-based prospective follow-up study to assess the association of HLA antigens with human lifespan.4, 5 During the assessment, which lasted from Dec 1, 1986, to March 1, 1988, 221 participants died before they could be visited. A total of 1037 people were eligible for the study, of whom 977 (94%) provided informed consent
Zutphen study
To obtain information on total cholesterol distribution from a comparable birth cohort at a younger age (born 1900–10), we used data on total cholesterol from the Zutphen Study—a longitudinal, population-based study of risk factors for chronic diseases among middle-aged men in the town of Zutphen in the Netherlands.9, 10 In 1960, a random sample of 1088 men was drawn from a total population of 2450 men, born 1900–19. 878 men aged 40–59 years were examined, and their serum samples stored at
Statistical analysis
Data are presented as mean (SD) unless otherwise stated. We compared groups by means of the Student's t test. Survival was estimated with the Kaplan-Meier product-limit method, compared with the log-rank test, and stratified for age and sex. Survival time for participants was defined as the period from the date of the home visit to the date of one of the following events: death from a specific cause, death from any cause, and Oct 1, 1996. Mortality risks and 95% CIs for the three categories of
Results
724 participants aged 85 years and older for whom total cholesterol concentrations were available are included in this analysis. Their baseline characteristics (table 1) did not differ from those of participants whose total cholesterol concentrations were unavailable (data not shown). The 724 participants are from a cohort of 1037 people in an impact study of the HLA system and survival (Leiden 85-plus study). Compared with the 1037 people eligible for the study, the cumulative 10-year
Discussion
The results of our study show that for both men and women of 85 years and older, high total serum cholesterol concentrations are inversely correlated with mortality—ie, high cholesterol is associated with increased survival. Compared with participants who had low total cholesterol concentrations, those with moderately high and high concentrations have a lower mortality risk of of 22% and 38%, respectively.
The total cholesterol concentration of the participants aged 85 years and over might not
References (27)
- et al.
The prevalence of morbidity in the oldest old, age 85 and over: a population-based survey in Leiden, the Netherlands
Arch Gerontol Geriatr
(1992) A note on the analysis of repeated measurements of the same subjects
J Chron Dis
(1962)- et al.
Report of the conference on low blood cholesterol: mortality associations
Circulation
(1992) - et al.
Lowering cholesterol concentrations and mortality: a quantative review of primary prevention trials
BMJ
(1990) - et al.
The effect of pravastin on coronary events after myocardial infarction in patients with average cholesterol levels
N Engl J Med
(1996) - et al.
The association between human leucocyte antigens (HLA) and mortality in community residents aged 85 and over
J Am Geriatr Soc
(1997) - et al.
Validation of medical history taking as part of a population based survey in subjects aged 85 and over
BMJ
(1992) International classification of diseases: manual of the international statistical classification of diseases, injuries, and causes of death
(1977)- et al.
Trends in infectious diseases mortality in the United States
JAMA
(1996) - et al.
Serum cholesterol and 25-year incidence of and mortality from infarction and cancer
Arch Intern Med
(1988)
Repeated measurements of serum cholesterol and blood pressure in relation to long-term incidence of myocardial infarction
Cardiology
Geriatric clinical chemistry reference values
Clarifying the direct relation between total cholesterol levels and death from coronary heart disease in older persons
Ann Intern Med
Cited by (431)
Sex differences in lipids: A life course approach
2023, AtherosclerosisStatins in Primary Prevention in People Over 80 Years
2023, American Journal of CardiologyImpact of preoperative nutritional scores on 1-year postoperative mortality in patients undergoing valvular heart surgery
2022, Journal of Thoracic and Cardiovascular SurgeryCardiovascular risk in the elderly population of Spain. The EPICARDIAN risk score
2022, Revista Clinica Espanola