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Low-density lipoprotein cholesterol in oldest old with acute myocardial infarction: Is lower the better?
Hui-Hui Liu1, Meng Zhang1, Run-Zhen Chen1
1Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 BeiLiShi Road, XiCheng District, Beijing 100037, China.
Insights
Low LDL-C levels (<1.8 mmol/l) are linked to higher cardiovascular mortality in elderly patients with acute myocardial infarction, particularly when combined with high hsCRP. This finding warrants further investigation in randomized controlled trials.
Area of Science:
- Cardiology
- Geriatrics
- Biochemistry
Background:
- The association between low-density lipoprotein cholesterol (LDL-C) and adverse outcomes in older adults is debated.
- Understanding this relationship is crucial for managing cardiovascular risk in the elderly population.
Purpose of the Study:
- To investigate the link between admission LDL-C levels and cardiovascular mortality (CVM) in individuals aged 80 years and above diagnosed with acute myocardial infarction (AMI).
- To explore the combined effect of LDL-C and high-sensitivity C-reactive protein (hsCRP) on CVM in this demographic.
Main Methods:
- A prospective, two-center cohort study involving 1,224 oldest old individuals with AMI.
- Participants were stratified by baseline LDL-C (<1.8, 1.8–2.6, ≥2.6 mmol/l) and hsCRP (<10, ≥10 mg/l) levels.
- Cardiovascular mortality was analyzed using Kaplan-Meier and multivariate Cox regression models.
Main Results:
- Individuals with LDL-C <1.8 mmol/l exhibited the highest CVM.
- A significantly lower risk of CVM was observed in patients with LDL-C ≥2.6 mmol/l compared to those with LDL-C <1.8 mmol/l (HR: 0.67, 95% CI: 0.46–0.98).
- The highest CVM was found in patients with low LDL-C and high hsCRP levels.
Conclusions:
- Low LDL-C (<1.8 mmol/l) is associated with increased CVM post-AMI in the oldest old, especially when hsCRP levels are high.
- These findings suggest a potential paradox in lipid management for elderly AMI patients and highlight the importance of hsCRP.
- Further validation through randomized controlled trials is recommended.
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.
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