Total cholesterol and risk of mortality in the oldest old
Abstract
Background The impact of total serum cholesterol as a risk factor for cardiovascular disease decreases with age, which casts doubt on the necessity for cholesterol-lowering therapy in the elderly. We assessed the influence of total cholesterol concentrations on specific and all-cause mortality in people aged 85 years and over. Methods In 724 participants (median age 89 years), total cholesterol concentrations were measured and mortality risks calculated over 10 years of follow-up. Three categories of total cholesterol concentrations were defined: < 5.0 mmol/L, 5.0-6.4 mmol/L, and > or = 6.5 mmol/L. In a subgroup of 137 participants, total cholesterol was measured again after 5 years of follow-up. Mortality risks for the three categories of total cholesterol concentrations were estimated with a Cox proportional-hazards model, adjusted for age, sex, and cardiovascular risk factors. The primary causes of death were coded according to the International Classification of Diseases (ICD-9). Findings During 10 years of follow-up from Dec 1, 1986, to Oct 1, 1996, a total of 642 participants died. Each 1 mmol/L increase in total cholesterol corresponded to a 15% decrease in mortality (risk ratio 0.85 [95% CI 0.79-0.91]). This risk estimate was similar in the subgroup of participants who had stable cholesterol concentrations over a 5-year period. The main cause of death was cardiovascular disease with a similar mortality risk in the three total cholesterol categories. Mortality from cancer and infection was significantly lower among the participants in the highest total cholesterol category than in the other categories, which largely explained the lower all-cause mortality in this category. Interpretation In people older than 85 years, high total cholesterol concentrations are associated with longevity owing to lower mortality from cancer and infection. The effects of cholesterol-lowering therapy have yet to be assessed.
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In old age, only levels of HDL cholesterol, but not total cholesterol, LDL cholesterol, and triglycerides, affect cardiovascular disease risk.
“In contrast, in old age, only levels of HDL cholesterol, but not of total cholesterol, LDL cholesterol, and triglycerides, affect cardiovascular disease risk [ 12, 32, 38, 39].”
From ApoE Plasma Levels and Risk of Cardiovascular Mortality in Old Age (2006) · cites this paper as [32]
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- Authors
- Weverling-Rijnsburger, A. W., Blauw, G. J., Lagaay, A. M., Knock, D. L., Meinders, A. E., & Westendorp, R. G.
- Affiliations
- Leiden University Medical Center (NL)
- ORCID
- Blauw, Gerard J
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1997-10
- Volume
- 350
- Issue
- 9085
- Pages
- 1119-1123
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2114338526
- Cited by
- 474
- References
- 0
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 10 · 2023: 10 · 2022: 11 · 2021: 13 · 2020: 14 · 2019: 19 · 2018: 13 · 2017: 13 · 2016: 9 · 2015: 13 · 2014: 14 · 2013: 23 · 2012: 19
- FWCI
- 20.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Paraoxonase enzyme and polymorphisms
- Keywords
- total cholesterol, oldest old, all-cause mortality, cardiovascular mortality, cancer mortality, infection-related mortality, longevity, cholesterol-lowering therapy, hypercholesterolemia
- MeSH terms
- Aged, Aged, 80 and over, Cardiovascular Diseases, Cause of Death, Cholesterol, Female, Follow-Up Studies, Humans, Infections, Longitudinal Studies, Male, Neoplasms, Netherlands, Prospective Studies, Risk Factors, Time Factors, Survival Rate, Proportional Hazards Models, Case-Control Studies
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