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Altered cardiovascular risk pattern of LDL cholesterol in older adults

Maarten Pieter Rozing1, Rudi G J Westendorp2

  • 1Section of General Practice and the Research Unit for General Practice.

Current Opinion in Lipidology
|November 22, 2022
PubMed

Insights

In older adults, high low-density lipoprotein cholesterol (LDL-C) is not a risk factor for cardiovascular events. Explanations include survivorship bias and reverse causation, but statin benefits in the elderly require further study.

Area of Science:

  • Gerontology
  • Cardiovascular Medicine
  • Epidemiology

Background:

  • Elevated serum low-density lipoprotein cholesterol (LDL-C) is a significant risk factor for cardiovascular events in middle-aged individuals.
  • In contrast, LDL-C levels in older populations are not predictive of cardiovascular mortality and may appear protective.
  • The reasons for this altered risk pattern in the elderly are debated, with potential roles for confounding and bias.

Approach:

  • This review examines recent literature to illustrate how LDL-C loses its predictive cardiovascular risk value in old age.
  • It explores three primary explanations for this phenomenon: survivorship bias, reverse causation, and effect modification.
  • The discussion focuses on observational data and the implications for understanding cardiovascular risk in aging populations.

Key Points:

  • Survivorship bias may explain why individuals with lower LDL-C survive to old age, skewing results.
  • Reverse causation suggests that declining health in older adults may lead to lower LDL-C levels.
  • Effect modification indicates that other factors may alter the relationship between LDL-C and cardiovascular risk in the elderly.

Conclusions:

  • The paradoxical findings regarding LDL-C and cardiovascular mortality in older adults can be attributed to survivorship bias, reverse causation, and effect modification.
  • These explanations do not negate the potential benefits of cholesterol-lowering therapies, such as statins, in older individuals.
  • Placebo-controlled trials are crucial for determining which elderly populations may benefit from lipid-lowering treatments.
Abstract

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