Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review. Issue 6 (12th June 2016)

• Record Type: Journal Article
• Authors: Ravnskov, Uffe; Diamond, David M; Hama, Rokura; Hamazaki, Tomohito; Hammarskjöld, Björn; Hynes, Niamh; Kendrick, Malcolm; Langsjoen, Peter H; Malhotra, Aseem; Mascitelli, Luca; McCully, Kilmer S; Ogushi, Yoichi; Okuyama, Harumi; Rosch, Paul J; Schersten, Tore; Sultan, Sherif; Sundberg, Ralf
• Is Part Of: BMJ open. Volume 6:Issue 6(2016)
• Publication Date: 2016-06-12
• Subjects: Risk factor, LDL-cholesterol, cardiovascular mortality, total mortality, elderly, -- GERIATRIC MEDICINE -- PREVENTIVE MEDICINE -- EPIDEMIOLOGY; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2015-010401
• Languages: English
• ISSNs: 2044-6055

Abstract

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.