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BMJ Open. 2016 Jun 12;6(6):e010401. doi: 10.1136/bmjopen-2015-010401.

Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review.

Author information

1
Magle Stora Kyrkogata 9, 22350 Lund, Sweden.
2
Department of Psychology, Department of Molecular Pharmacology and Physiology, Center for Preclinical and Clinical Research on PTSD, University of South Florida, Tampa, Florida, USA.
3
NPO Japan Institute of Pharmacovigilance, Osaka, Japan.
4
Department of Internal Medicine, Toyama Jonan Onsen Daini Hospital, University of Toyama, Toyama City, Japan.
5
Strömstad Academy, Strömstad, Sweden.
6
Western Vascular Institute, University Hospital Galway & Galway Clinic, National University of Ireland & Royal college of Surgeons of Ireland affiliated Hospital, Galway, Ireland.
7
East Cheshire Trust, Macclesfield District General Hospital, Macclesfield, Cheshire, England.
8
Solo Practice in Cardiology, Tyler, Texas 75701, USA.
9
Department of cardiology, Frimley Park Hospital, Portsmouth road, Surrey GU16 7UJ, UK.
10
Medical Service, Comando Brigata Alpina "Julia"/Multinational Land Force, Udine, Italy.
11
Pathology and Laboratory Medicine Service, VA Boston Healthcare System, West Roxbury; Harvard Medical School, Boston, Massachusetts.
12
Tokai University, Daikancho, Hiratsuka, Kanagawa, Japan 254-0807.
13
Nagoya City University and Institute for Consumer Science and Human Life, Kinjo Gakuin University, Nagoya, Japan.
14
New York Medical College; The American Institute of Stress.
15
Sahlgren's Academy, University of Gothenburg, Sweden, and Colombia University, NY, USA.
16
Slottsstadens Läkarhus, Malmö, Gothenburg, Sweden.

Abstract

OBJECTIVE:

It is well known that total cholesterol becomes less of a risk factor or not at all for all-cause and cardiovascular (CV) mortality with increasing age, but as little is known as to whether low-density lipoprotein cholesterol (LDL-C), one component of total cholesterol, is associated with mortality in the elderly, we decided to investigate this issue.

SETTING, PARTICIPANTS AND OUTCOME MEASURES:

We sought PubMed for cohort studies, where LDL-C had been investigated as a risk factor for all-cause and/or CV mortality in individuals ≥60 years from the general population.

RESULTS:

We identified 19 cohort studies including 30 cohorts with a total of 68 094 elderly people, where all-cause mortality was recorded in 28 cohorts and CV mortality in 9 cohorts. Inverse association between all-cause mortality and LDL-C was seen in 16 cohorts (in 14 with statistical significance) representing 92% of the number of participants, where this association was recorded. In the rest, no association was found. In two cohorts, CV mortality was highest in the lowest LDL-C quartile and with statistical significance; in seven cohorts, no association was found.

CONCLUSIONS:

High LDL-C is inversely associated with mortality in most people over 60 years. This finding is inconsistent with the cholesterol hypothesis (ie, that cholesterol, particularly LDL-C, is inherently atherogenic). Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis. Moreover, our study provides the rationale for a re-evaluation of guidelines recommending pharmacological reduction of LDL-C in the elderly as a component of cardiovascular disease prevention strategies.

KEYWORDS:

EPIDEMIOLOGY; GERIATRIC MEDICINE; PREVENTIVE MEDICINE; Risk factor, LDL-cholesterol, cardiovascular mortality, total mortality, elderly,

PMID:
27292972
PMCID:
PMC4908872
DOI:
10.1136/bmjopen-2015-010401
[Indexed for MEDLINE]
Free PMC Article

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