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Does plasma cholesterol concentration predict mortality from coronary heart disease in elderly people? 18 year follow
M J Shipley1, S J Pocock, M G Marmot
1Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine.
Insights
Lowering plasma cholesterol in middle age may reduce coronary heart disease deaths in older men. This study tracked cholesterol and mortality in male civil servants over 18 years.
Area of Science:
- Cardiovascular epidemiology
- Gerontology
- Public health
Background:
- The relationship between plasma cholesterol and coronary heart disease (CHD) mortality is well-established in middle-aged men.
- However, the persistence of this association into older age requires further investigation.
Purpose of the Study:
- To examine the association between plasma cholesterol concentration and the risk of death from coronary heart disease (CHD) in aging men.
- To determine if this association remains significant in older age groups.
Main Methods:
- An 18-year follow-up study of 18,296 male civil servants, aged 40-69 at baseline (1967-9).
- Plasma cholesterol levels and other risk factors were measured at baseline.
- Mortality data, including cause and age of death, were recorded until January 1987.
Main Results:
- A total of 1,676 men died from CHD.
- Men who died from CHD had a mean cholesterol concentration 0.32 mmol/l higher than other men.
- The association between cholesterol and CHD mortality risk decreased with increasing age at screening and death, but remained significant.
Conclusions:
- Plasma cholesterol levels measured in middle age can predict the risk of death from coronary heart disease in old age.
- Interventions to reduce plasma cholesterol in middle age may have long-term benefits for cardiovascular health in later life.
Objective:
To explore the extent to which the relation between plasma cholesterol concentration and risk of death from coronary heart disease in men persists into old age.
Design:
18 year follow up of male Whitehall civil servants. Plasma cholesterol concentrations and other risk factors were determined at first examination in 1967-9 when they were aged 40-69. Death of men up to 31 January 1987 was recorded.
Subjects:
18,296 male civil servants, 4155 of whom died during follow up.
Main Outcome Measures:
Cause and age of death. Cholesterol concentration in 1967-9 and number of years elapsed between testing and death.
Results:
1676 men died of coronary heart disease. The mean cholesterol concentration in these men was 0.32 mmol/l higher than that in all other men (95% confidence interval 0.26 to 0.37 mmol/l). This difference in cholesterol concentrations fell 0.15 mmol/l with every 10 years' increase in age at screening. The risk of raised cholesterol concentration fell with age at death. Compared with other men cholesterol concentration in those who died of coronary heart disease was 0.44 mmol/l higher in those who died aged less than 60 and 0.26 mmol/l higher in those aged 60-79 (p = 0.03). For a given age at death the longer the gap between cholesterol measurement and death the more predictive the cholesterol concentration, both for coronary heart disease and all cause mortality (trend test p = 0.06 and 0.03 respectively).
Conclusion:
Reducing plasma cholesterol concentrations in middle age may influence the risk of death from coronary heart disease in old age.
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