Hypercholesterolemia and coronary heart disease in the elderly: a meta-analysis

doi:10.1016/j.annepidem.2003.10.009

Annals of Epidemiology

Volume 14, Issue 9, October 2004, Pages 705-721

https://doi.org/10.1016/j.annepidem.2003.10.009 Get rights and content

Abstract

Purpose

To determine whether hypercholesterolemia is an independent risk factor for CHD morbidity and mortality in persons aged 65 years and above, and to quantify the magnitude of the association, if any, using data from follow-up studies.

Methods

A MEDLINE search of all published studies that evaluated the association between high cholesterol levels and CHD in persons aged 65 years and above, and the relevant articles referenced in these studies, were used as sources of selected articles.

Results

In men aged 65 years and above who were followed from middle age, the RR for CHD incidence associated with 1.0 mmol/L increase in total cholesterol was 1.28 (CI: 1.17–1.39). The RR for CHD mortality associated with a similar increase in total cholesterol was 1.22 (CI: 1.18–1.27). In elderly men followed from age 65 and above, the RR was 1.24 (CI: 1.1–1.37) for CHD incidence, and 1.22(CI: 1.15–1.28) for CHD mortality. In elderly women followed after age 65, the association between total cholesterol and CHD mortality was not significant. For men aged 80 years and above at entry, total cholesterol showed an inverse relationship with all-cause mortality.

Conclusion

Serum total cholesterol shows a positive association with CHD morbidity and mortality in men aged 65 years and above. This may, however, not hold true for persons aged 80 years and above.

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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Hypercholesterolemia and coronary heart disease in the elderly: a meta-analysis

Abstract

Purpose

Methods

Results

Conclusion

Introduction

Section snippets

Data source

Results

Discussion

Conclusion

Acknowledgements

Total cholesterol and mortality after age 80 years

Lancet

Total cholesterol and risk of mortality in the oldest old

Lancet

Cardiovascular risk-factor reduction in elderly patients with cardiac disease

Phys Ther

Cholesterol and heart disease in older persons and women. Review of an NHLBI workshop

Ann Epidemiol

Proportional hazards analysis of risk factors for coronary heart disease in individuals aged 65 or older. The Framingham Heart Study

J Am Geriatr Soc

Total serum cholesterol levels and mortality risk as a function of age. A report based on the Framingham data

Arch Intern Med

Role of smoking in the U-shaped relation of cholesterol to mortality in men. The Framingham Study

Am J Epidemiol

Lipids and risk of coronary heart disease. The Framingham Study

Ann Epidemiol

Prognostic value of cholesterol in women of different ages

J Womens Health

Is elevated serum cholesterol level a risk factor for coronary heart disease in the elderly?

JAMA

elevated serum cholesterol is a risk factor for both coronary heart disease and thromboembolic stroke in Hawaiian Japanese men. Implications of shared risk

Stroke

Lipid and lipoprotein predictors of coronary heart disease in elderly men in the Honolulu Heart Program

Ann Epidemiol

Krumholz HM, Seeman TE, Merrill SS, Mendes de Leon CF, Vaccarino V, Silverman DI, et al., Lack of association between cholesterol and coronary heart disease mortality in persons older than 70 years

JAMA

HDL cholesterol predicts coronary heart disease mortality in older persons

JAMA

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

Ann Intern Med

Does the predictive value of baseline coronary risk factors change over a 30-year follow-up?

Cardiology

Risk factors of coronary heart disease and total mortality among elderly men with and without preexisting coronary heart disease. Finnish cohorts of the Seven Countries Study

J Am Coll Cardiol

Total and high density lipoprotein cholesterol as risk factors for coronary heart disease in elderly men during 5 years of follow-up. The Zutphen Elder Study

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Total but not high-density lipoprotein cholesterol is consistently associated with coronary heart disease mortality in elderly men in Finland, Italy, and the Netherlands

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Ann Epidemiol

Hypercholesterolemia predicts early death from coronary heart disease in elderly men but not women. The Rancho Bernardo Study

Ann Epidemiol

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Cardiology

Serum cholesterol and 20-year mortality in black and white men and women aged 65 and older in the Evans County Heart Study

Ann Epidemiol

Serum cholesterol—risk factor for coronary disease in younger and older blacks and whites. The Charleston Heart Study, 1960–1988

Ann Epidemiol