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. 2016 Jun 12;6(6):e010401.
doi: 10.1136/bmjopen-2015-010401.

Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review

Uffe Ravnskov  1 , David M Diamond  2 , Rokura Hama  3 , Tomohito Hamazaki  4 , Björn Hammarskjöld  5 , Niamh Hynes  6 , Malcolm Kendrick  7 , Peter H Langsjoen  8 , Aseem Malhotra  9 , Luca Mascitelli  10 , Kilmer S McCully  11 , Yoichi Ogushi  12 , Harumi Okuyama  13 , Paul J Rosch  14 , Tore Schersten  15 , Sherif Sultan  6 , Ralf Sundberg  16
Affiliations

Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review

Uffe Ravnskov et al. BMJ Open. .

Abstract

Objective: 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.

Setting, participants and outcome measures: 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.

Results: 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.

Conclusions: 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.

Keywords: EPIDEMIOLOGY; GERIATRIC MEDICINE; PREVENTIVE MEDICINE; Risk factor, LDL-cholesterol, cardiovascular mortality, total mortality, elderly,.

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Figures

Figure 1
Figure 1
Flow Chart. CV, cardiovascular; LDL-C, low-density lipoprotein cholesterol.
See this image and copyright information in PMC

References

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