Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study.
BACKGROUND
A generally held belief is that cholesterol concentrations should be kept low to lessen the risk of cardiovascular disease. However, studies of the relation between serum cholesterol and all-cause mortality in elderly people have shown contrasting results. To investigate these discrepancies, we did a longitudinal assessment of changes in both lipid and serum cholesterol concentrations over 20 years, and compared them with mortality.


METHODS
Lipid and serum cholesterol concentrations were measured in 3572 Japanese/American men (aged 71-93 years) as part of the Honolulu Heart Program. We compared changes in these concentrations over 20 years with all-cause mortality using three different Cox proportional hazards models.


RESULTS
Mean cholesterol fell significantly with increasing age. Age-adjusted mortality rates were 68.3, 48.9, 41.1, and 43.3 for the first to fourth quartiles of cholesterol concentrations, respectively. Relative risks for mortality were 0.72 (95% CI 0.60-0.87), 0.60 (0.49-0.74), and 0.65 (0.53-0.80), in the second, third, and fourth quartiles, respectively, with quartile 1 as reference. A Cox proportional hazard model assessed changes in cholesterol concentrations between examinations three and four. Only the group with low cholesterol concentration at both examinations had a significant association with mortality (risk ratio 1.64, 95% CI 1.13-2.36).


CONCLUSIONS
We have been unable to explain our results. These data cast doubt on the scientific justification for lowering cholesterol to very low concentrations (<4.65 mmol/L) in elderly people.
Schatz
I J
IJ
Clinical Epidemiology and Geriatrics Division, Department of Medicine, John A Bums School of Medicine, University of Hawaii at Manoa, 1356 Lusitana Street, 7th Floor, Honolulu, HI 96813-2427, USA. schatzi@hawaii.edu
Masaki
K
K
Yano
K
K
Chen
R
R
Rodriguez
B L
BL
Curb
J D
JD
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000097:blood; D001213:Asian; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000401:mortality*; D002784:Cholesterol / Q000097:blood*; D015331:Cohort Studies; D005500:Follow-Up Studies; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D013997:Time Factors
D002784:Cholesterol