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Cholesterol fractions and apolipoproteins as risk factors for heart disease mortality in older men

Robert Clarke1, Jonathan R Emberson, Sarah Parish

  • 1Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, England. robert.clarke@ctsu.ox.ac.uk

Archives of Internal Medicine
|July 11, 2007
PubMed

Insights

Blood lipid levels, excluding total cholesterol, are linked to ischemic heart disease (IHD) risk in older men. Achieving lipid level differences seen with statin use may reduce IHD risk by one-third.

Area of Science:

  • Cardiovascular Medicine
  • Gerontology
  • Lipidology

Background:

  • The role of blood lipids in ischemic heart disease (IHD) risk for older adults remains unclear, leading to infrequent cholesterol-lowering therapy prescription in this demographic.
  • Existing guidelines do not routinely recommend cholesterol-lowering treatments for the elderly due to uncertain IHD risk associations.

Purpose of the Study:

  • To investigate the association between various blood lipid levels and IHD mortality in an aging male population.
  • To clarify the predictive value of specific lipid markers for cardiovascular events in older men.

Main Methods:

  • A 7-year follow-up study of 5344 men (mean age 76.9 years) was conducted, assessing plasma levels of total cholesterol, LDL cholesterol, HDL cholesterol, apolipoprotein B, and apolipoprotein A(1).
  • The cohort included individuals with and without pre-existing cardiovascular disease (CVD) or statin use.
  • Hazard ratios (HRs) for 447 IHD deaths were calculated for a 2-standard deviation difference in lipid levels.

Main Results:

  • Total cholesterol levels showed no significant association with IHD mortality overall, but a positive association was found in men without CVD and a non-significant inverse association in men with CVD.
  • Low-density lipoprotein cholesterol and apolipoprotein B levels demonstrated similar patterns, with higher risks in men without CVD.
  • High-density lipoprotein cholesterol and apolipoprotein A(1) levels were inversely associated with IHD risk in both subgroups.
  • Combined lipid ratios (total/HDL cholesterol and apolipoprotein B/A(1)) showed strong associations with IHD risk across all ages.

Conclusions:

  • Blood lipid profiles, beyond total cholesterol, are significantly associated with IHD risk in older men.
  • Lipid level modifications achievable with statin therapy correlate with a substantial reduction (approximately one-third) in IHD risk, regardless of age.
Abstract

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