Low-density lipoprotein cholesterol in oldest old with acute myocardial infarction: Is lower the better?. (11th September 2022)

• Record Type: Journal Article
• Authors: Liu, Hui-Hui; Zhang, Meng; Chen, Run-Zhen; Zhou, Jin-Ying; Qian, Jie; Dou, Ke-Fei; Yan, Hong-Bing; Li, Jian-Jun
• Is Part Of: Age and ageing. Volume 51:Number 9(2022)
• Publication Date: 2022-09-11
• Subjects: oldest -- lipoprotein -- inflammation -- cardiovascular -- mortality -- older people; Aging -- Periodicals; Geriatrics -- Periodicals; 618.97
• DOI: 10.1093/ageing/afac202
• Languages: English
• ISSNs: 0002-0729

Abstract

Abstract: Background: the relationship between low-density lipoprotein cholesterol (LDL-C) and adverse outcomes among the older people remains controversial. Objective: to further clarify the association between admission LDL-C levels and cardiovascular mortality (CVM) among oldest old individuals (≥80 years) with acute myocardial infarction (AMI). Design: a prospective cohort study. Setting: two-centre. Subjects: a consecutive sample of 1, 224 oldest old individuals with AMI admitted to Beijing FuWai and Shenzhen FuWai hospitals. Methods: all individuals were subdivided according to baseline LDL-C levels (<1.8, 1.8–2.6 and ≥ 2.6 mmol/l) and further stratified by high-sensitivity C-reactive protein (hsCRP) concentrations (<10 and ≥10 mg/l). The primary outcome was CVM. The time from admission to the occurrence of CVM or the last follow-up was analysed in Kaplan–Meier and Cox analyses. Results: the median age of the overall population was 82 years. During an average of 24.5 months' follow-up, 299 cardiovascular deaths occurred. Kaplan–Meier analysis showed that LDL-C < 1.8 mmol/l group had the highest CVM among oldest old individuals with AMI. Multivariate Cox regression analysis further revealed that compared with those with LDL-C levels <1.8 mmol/l, subjects with LDL-C levels ≥2.6 mmol/l (hazard ratio: 0.67, 95% confidence interval: 0.46–0.98) had significantly lower risk of CVM, especially in those with high hsCRP levels. Moreover, when categorising according to LDL-C and hsCRP together, data showed that individuals with low LDL-C and high hsCRP levels had the highest CVM. Conclusions: LDL-C < 1.8 mmol/l was associated with a high CVM after AMI in oldest old individuals, especially when combined with high hsCRP levels, which may need to be confirmed by randomised controlled trials.