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Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study

I J Schatz1, K Masaki, K Yano

  • 1Clinical Epidemiology and Geriatrics Division, Department of Medicine, John A Bums School of Medicine, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor, Honolulu, HI 96813-2427, USA. schatzi@hawaii.edu

Lancet (London, England)
|August 15, 2001
PubMed

Insights

Lowering cholesterol in elderly individuals may not reduce mortality risk, as low cholesterol levels were associated with increased mortality in a 20-year study. These findings challenge current recommendations for cholesterol management in older adults.

Area of Science:

  • Gerontology
  • Cardiovascular Disease Research
  • Epidemiology

Background:

  • A prevailing belief suggests low cholesterol reduces cardiovascular disease risk.
  • Existing studies on serum cholesterol and mortality in the elderly show conflicting results.
  • This study addresses discrepancies by examining lipid and cholesterol changes over 20 years in relation to mortality.

Purpose of the Study:

  • To longitudinally assess changes in lipid and serum cholesterol concentrations over two decades.
  • To compare these concentration changes with all-cause mortality in elderly Japanese/American men.
  • To investigate the association between cholesterol levels and mortality risk in an aging population.

Main Methods:

  • A 20-year longitudinal study of 3572 Japanese/American men (aged 71-93 years).
  • Measurement of lipid and serum cholesterol concentrations.
  • Analysis using three Cox proportional hazards models to compare changes with all-cause mortality.

Main Results:

  • Mean cholesterol levels significantly decreased with age.
  • Mortality rates were highest in the lowest cholesterol quartile.
  • Sustained low cholesterol concentrations were significantly associated with increased mortality risk (risk ratio 1.64).

Conclusions:

  • The study's findings could not be readily explained by current understanding.
  • Data suggest that lowering cholesterol to very low concentrations (<4.65 mmol/L) in the elderly may lack scientific justification.
  • These results question the universal recommendation for aggressive cholesterol reduction in older populations.
Abstract

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