Hypercholesterolemia and coronary heart disease in the elderly: a meta-analysis
Introduction
In middle age, total cholesterol levels and high density lipoprotein cholesterol (HDL-C) levels have been established as risk factors for coronary heart disease (CHD) but the role of lipoprotein in persons aged 65 years and above, remains controversial. Variable findings have been reported in the elderly, some showing a positive association with others showing no significant association. Other studies in persons aged 80 years and above have even shown an inverse relationship between high total serum cholesterol and CHD mortality 1., 2..
Elderly persons aged 65 years and above are the fastest growing age group in the United States. Individuals join the ranks of the elderly population at the rate of approximately a thousand per day (3). A report from the NHLBI workshop that looked at cholesterol and heart disease in middle-aged (<65 years) and older men and women (⩾65 years) in 1991 (4) reported a less consistent association of cholesterol with fatal CHD in older men. For women aged 65 and above, the association between total cholesterol and CHD mortality was not as strong and consistent as in middle-aged women. Since the publication of this review article more recent follow-up studies have not helped much in clarifying the issue of whether total cholesterol is an independent risk factor for CHD in the elderly 5., 6., 7., 8., 9., 10., 11., 12., 13., 14., 15., 16., 17., 18., 19., 20., 21., 22., 23., 24., 25., 26..
The purpose of this study is to determine whether hypercholesterolemia is an independent risk factor for CHD morbidity and mortality in the persons aged 65 years and above and to quantify the magnitude of the association, if any, using data from recent follow-up studies.
Section snippets
Data source
A MEDLINE search of all published studies that evaluated the association between high cholesterol levels and coronary heart disease incidence and/or mortality in persons aged 65 years and above, and the relevant articles referenced in these studies were used as sources of selected articles. This was achieved by using “hypercholesterolemia and CHD in the elderly” as the search words. The search criteria netted 51 studies.
Studies were selected for inclusion if all of the following are answered in
Results
The studies entered for analyses had follow-up periods ranging from 3 to 32 years (Table 1). The relative risk for CHD incidence, due to a cholesterol level ⩾240 mg/dL vs. <200 mg/dL, ranged from 1.1 to 1.7 for men, and 0.9 to 1.4 for women (Table 2). For CHD mortality, the relative risk ranged from 0.83 to 2.10 for men, and 0.7 to 2.35 for women.
Discussion
The findings from this study show that total serum cholesterol shows a positive association with CHD events in men aged 65 years and above. However, for persons aged about 80 years and above, the association with CHD mortality has been reported as not statistically significant 6., 15.. Serum total cholesterol is predictive of CHD mortality in middle-aged men. The 1991 analysis at the NHLBI workshop puts the magnitude at 1.73 (unadjusted), for a cholesterol level of 240 mg/dl and above vs. a
Conclusion
Serum total cholesterol shows a positive association with CHD morbidity and mortality in men aged 65 years and above. Studies that reported on the association between total cholesterol and CHD mortality in men aged 80 years and above, did not find any significant association. Serum total cholesterol also showed an inverse relationship with all-cause mortality for persons aged 80 years and above.
Acknowledgements
The authors express their sincere appreciation to Shu-Chuan Jennifer Yeh, Ph.D., who did a thorough MEDLINE search of all relevant articles from 1991 to 1996.
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