Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review.
It is well known that total cholesterol becomes less of a risk factor or not at all for all-cause and cardiovascular (CV) mortality with increasing age, but as little is known as to whether low-density lipoprotein cholesterol (LDL-C), one component of total cholesterol, is associated with mortality in the elderly, we decided to investigate this issue.



We sought PubMed for cohort studies, where LDL-C had been investigated as a risk factor for all-cause and/or CV mortality in individuals ≥60 years from the general population.



We identified 19 cohort studies including 30 cohorts with a total of 68 094 elderly people, where all-cause mortality was recorded in 28 cohorts and CV mortality in 9 cohorts. Inverse association between all-cause mortality and LDL-C was seen in 16 cohorts (in 14 with statistical significance) representing 92% of the number of participants, where this association was recorded. In the rest, no association was found. In two cohorts, CV mortality was highest in the lowest LDL-C quartile and with statistical significance; in seven cohorts, no association was found.



High LDL-C is inversely associated with mortality in most people over 60 years. This finding is inconsistent with the cholesterol hypothesis (ie, that cholesterol, particularly LDL-C, is inherently atherogenic). Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis. Moreover, our study provides the rationale for a re-evaluation of guidelines recommending pharmacological reduction of LDL-C in the elderly as a component of cardiovascular disease prevention strategies.
Magle Stora Kyrkogata 9, 22350 Lund, Sweden.
Uffe
U
Ravnskov
Department of Psychology, Department of Molecular Pharmacology and Physiology, Center for Preclinical and Clinical Research on PTSD, University of South Florida, Tampa, Florida, USA.
David M
DM
Diamond
NPO Japan Institute of Pharmacovigilance, Osaka, Japan.
Rokura
R
Hama
Department of Internal Medicine, Toyama Jonan Onsen Daini Hospital, University of Toyama, Toyama City, Japan.
Tomohito
T
Hamazaki
Strömstad Academy, Strömstad, Sweden.
Björn
B
Hammarskjöld
Western Vascular Institute, University Hospital Galway & Galway Clinic, National University of Ireland & Royal college of Surgeons of Ireland affiliated Hospital, Galway, Ireland.
Niamh
N
Hynes
East Cheshire Trust, Macclesfield District General Hospital, Macclesfield, Cheshire, England.
Malcolm
M
Kendrick
Solo Practice in Cardiology, Tyler, Texas 75701, USA.
Peter H
PH
Langsjoen
Department of cardiology, Frimley Park Hospital, Portsmouth road, Surrey GU16 7UJ, UK.
Aseem
A
Malhotra
Medical Service, Comando Brigata Alpina "Julia"/Multinational Land Force, Udine, Italy.
Luca
L
Mascitelli
Pathology and Laboratory Medicine Service, VA Boston Healthcare System, West Roxbury; Harvard Medical School, Boston, Massachusetts.
Kilmer S
KS
McCully
Tokai University, Daikancho, Hiratsuka, Kanagawa, Japan 254-0807.
Yoichi
Y
Ogushi
Nagoya City University and Institute for Consumer Science and Human Life, Kinjo Gakuin University, Nagoya, Japan.
Harumi
H
Okuyama
New York Medical College; The American Institute of Stress.
Paul J
PJ
Rosch
Sahlgren's Academy, University of Gothenburg, Sweden, and Colombia University, NY, USA.
Tore
T
Schersten
Western Vascular Institute, University Hospital Galway & Galway Clinic, National University of Ireland & Royal college of Surgeons of Ireland affiliated Hospital, Galway, Ireland.
Sherif
S
Sultan
Slottsstadens Läkarhus, Malmö, Gothenburg, Sweden.
Ralf
R
Sundberg
D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D008078:Cholesterol, LDL / Q000097:blood*; D006801:Humans; D008875:Middle Aged; D009026:Mortality; D012307:Risk Factors
D008078:Cholesterol, LDL
EPIDEMIOLOGY; GERIATRIC MEDICINE; PREVENTIVE MEDICINE; Risk factor, LDL-cholesterol, cardiovascular mortality, total mortality, elderly,