The value of serum albumin and high-density lipoprotein cholesterol in defining mortality risk in older persons with low serum cholesterol.
OBJECTIVE
To investigate the relationship between low cholesterol and mortality in older persons to identify, using information collected at a single point in time, subgroups of persons with low and high mortality risk.


METHODS
Prospective cohort study with a median follow-up period of 4.9 years.


METHODS
East Boston, Massachusetts; New Haven, Connecticut; and Iowa and Washington counties, Iowa.


METHODS
Four thousand one hundred twenty-eight participants (64% women) age 70 and older at baseline (mean 78.7 years, range 70-103); 393 (9.5%) had low cholesterol, defined as < or =160 mg/dl.


METHODS
All-cause mortality and mortality not related to coronary heart disease and ischemic stroke.


RESULTS
During the follow-up period there were 1,117 deaths. After adjustment for age and gender, persons with low cholesterol had significantly higher mortality than those with normal and high cholesterol. Among subjects with low cholesterol, those with albumin> 38 g/L had a significant risk reduction compared with those with albumin < or =38 g/L (relative risk (RR) = 0.57; 95% confidence interval (CI) = 0.41-0.79). Within the higher albumin group, high-density lipoprotein cholesterol (HDL-C) level further identified two subgroups of subjects with different risks; participants with HDL-C <47 mg/dl had a 32% risk reduction (RR = 0.68; 95% CI = 0.47-0.99) and those with HDL-C > or =47 mg/dl had a 62% risk reduction (RR = 0.38; 95% CI = 0.20-0.68), compared with the reference category; those with albumin < or =38 g/L and HDL-C <47 mg/dl.


CONCLUSIONS
Older persons with low cholesterol constitute a heterogeneous group with regard to health characteristics and mortality risk. Serum albumin and HDL-C can be routinely used in older patients with low cholesterol to distinguish three subgroups with different prognoses: (1) high risk (low albumin), (2) intermediate risk (high albumin and low HDL-C), and (3) low risk (high albumin and high HDL-C).
Volpato
S
S
Epidemiology, Demography and Biometry Program, National Institute on Aging, Bethesda, Maryland 20892, USA.
Leveille
S G
SG
Corti
M C
MC
Harris
T B
TB
Guralnik
J M
JM
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001900:Boston / Q000453:epidemiology; D002423:Cause of Death; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood*; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D008297:Male; D009026:Mortality; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012709:Serum Albumin; D016019:Survival Analysis
D008076:Cholesterol, HDL; D012709:Serum Albumin; D002784:Cholesterol