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Meta-Analysis
. 2023 Aug 27;78(9):1708-1716.
doi: 10.1093/gerona/glad148.

The Role of a Composite Fitness Score in the Association Between Low-Density Cholesterol and All-Cause Mortality in Older Adults: An Individual Patient Data Meta-Analysis

Milly A van der Ploeg  1 , Rosalinde K E Poortvliet  1 , Jonathan M K Bogaerts  1 , Veerle M G T H van der Klei  2 , Ngaire Kerse  3 , Anna Rolleston  4 , Ruth Teh  3 , Louise Robinson  5 , Carol Jagger  5 , Yasumichi Arai  6 , Ryo Shikimoto  6 , Yukiko Abe  6 , Jeanet W Blom  1 , Yvonne M Drewes  1   2 , Jacobijn Gussekloo  1   2
Affiliations
Meta-Analysis

The Role of a Composite Fitness Score in the Association Between Low-Density Cholesterol and All-Cause Mortality in Older Adults: An Individual Patient Data Meta-Analysis

Milly A van der Ploeg et al. J Gerontol A Biol Sci Med Sci. .

Abstract

Background: In the general population, an increase in low-density lipoprotein cholesterol (LDL-C) predicts higher cardiovascular disease risk, and lowering LDL-C can prevent cardiovascular disease and reduces mortality risk. Interestingly, in cohort studies that include very old populations, no or inverse associations between LDL-C and mortality have been observed. This study aims to investigate whether the association between LDL-C and mortality in the very old is modified by a composite fitness score.

Methods: A 2-stage meta-analysis of individual participant data from the 5 observational cohort studies. The composite fitness score was operationalized by performance on a combination of 4 markers: functional ability, cognitive function, grip strength, and morbidity. We pooled hazard ratios (HR) from Cox proportional-hazards models for 5-year mortality risk for a 1 mmol/L increase in LDL-C. Models were stratified by high/low composite fitness score.

Results: Composite fitness scores were calculated for 2 317 participants (median 85 years, 60% females participants), of which 994 (42.9%) had a high composite fitness score, and 694 (30.0%) had a low-composite fitness score. There was an inverse association between LDL-C and 5-year mortality risk (HR 0.87 [95% CI: 0.80-0.94]; p < .01), most pronounced in participants with a low-composite fitness score (HR 0.85 [95% CI: 0.75-0.96]; p = .01), compared to those with a high composite fitness score (HR = 0.98 [95% CI: 0.83-1.15]; p = .78), the test for subgroups differences was not significant.

Conclusions: In this very old population, there was an inverse association between LDL-C and all-cause mortality, which was most pronounced in participants with a low-composite fitness scores.

Keywords: Activities of daily living; Cognition; Frailty; Grip strength; Oldest old.

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Conflict of interest statement

All authors declare that they have nothing to disclose.

Figures

Figure 1.
Figure 1.
Five-year all-cause mortality risk according to LDL-C level per 1.0 mmol/L in older adults, adjusted for age, gender, and use of lipid-lowering medication. LDL-C = low-density cholesterol.
Figure 2.
Figure 2.
Five-year all-cause mortality risk according to LDL-C level per 1.0 mmol/L, in older adults, adjusted for age, gender, and use of lipid-lowering medication, stratified on composite fitness score. LDL-C = low-density cholesterol.
See this image and copyright information in PMC

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