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Clarifying the direct relation between total cholesterol levels and death from coronary heart disease in older

M C Corti1, J M Guralnik, M E Salive

  • 1National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892-9205, USA.

Annals of Internal Medicine
|May 15, 1997
PubMed

Insights

Total cholesterol is a risk factor for coronary heart disease death in older adults. Low cholesterol levels may indicate frailty and comorbidity, not a protective effect.

Area of Science:

  • Gerontology
  • Cardiovascular Medicine
  • Epidemiology

Background:

  • The role of total cholesterol in coronary heart disease (CHD) risk among older adults remains debated.
  • Previous studies have yielded conflicting results regarding cholesterol's impact on CHD mortality in this demographic.

Purpose of the Study:

  • To investigate if prior findings of non-significant cholesterol as a CHD risk factor in older adults were due to insufficient adjustment for comorbidities and frailty.
  • To clarify the relationship between total cholesterol levels and CHD mortality in the elderly population.

Main Methods:

  • A multicenter, longitudinal study involving 4066 participants.
  • Follow-up for mortality over a 5-year period (1988-1992).
  • Data collection included health status interviews and blood sample analysis.

Main Results:

  • Initially, lowest cholesterol levels (<4.15 mmol/L) showed the highest CHD death rate, while elevated levels (>6.20 mmol/L) appeared protective (P=0.04).
  • After adjusting for risk factors, frailty, and excluding early deaths, elevated total cholesterol predicted increased CHD mortality (P=0.005).
  • The risk of CHD death decreased as cholesterol levels decreased following adjustments.

Conclusions:

  • Elevated total cholesterol is confirmed as a risk factor for CHD death in older adults.
  • Adverse associations with low cholesterol are attributed to underlying comorbidity and frailty.
  • Cholesterol screening in older adults is appropriate, but results require careful clinical interpretation.
Abstract

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