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

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...

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Autores principales: Ravnskov, Uffe, Diamond, David M, Hama, Rokura, Hamazaki, Tomohito, Hammarskjöld, Björn, Hynes, Niamh, Kendrick, Malcolm, Langsjoen, Peter H, Malhotra, Aseem, Mascitelli, Luca, McCully, Kilmer S, Ogushi, Yoichi, Okuyama, Harumi, Rosch, Paul J, Schersten, Tore, Sultan, Sherif, Sundberg, Ralf
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908872/
https://www.ncbi.nlm.nih.gov/pubmed/27292972
http://dx.doi.org/10.1136/bmjopen-2015-010401
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author Ravnskov, Uffe
Diamond, David M
Hama, Rokura
Hamazaki, Tomohito
Hammarskjöld, Björn
Hynes, Niamh
Kendrick, Malcolm
Langsjoen, Peter H
Malhotra, Aseem
Mascitelli, Luca
McCully, Kilmer S
Ogushi, Yoichi
Okuyama, Harumi
Rosch, Paul J
Schersten, Tore
Sultan, Sherif
Sundberg, Ralf
author_facet Ravnskov, Uffe
Diamond, David M
Hama, Rokura
Hamazaki, Tomohito
Hammarskjöld, Björn
Hynes, Niamh
Kendrick, Malcolm
Langsjoen, Peter H
Malhotra, Aseem
Mascitelli, Luca
McCully, Kilmer S
Ogushi, Yoichi
Okuyama, Harumi
Rosch, Paul J
Schersten, Tore
Sultan, Sherif
Sundberg, Ralf
author_sort Ravnskov, Uffe
collection PubMed
description 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.
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spelling pubmed-49088722016-06-22 Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review Ravnskov, Uffe Diamond, David M Hama, Rokura Hamazaki, Tomohito Hammarskjöld, Björn Hynes, Niamh Kendrick, Malcolm Langsjoen, Peter H Malhotra, Aseem Mascitelli, Luca McCully, Kilmer S Ogushi, Yoichi Okuyama, Harumi Rosch, Paul J Schersten, Tore Sultan, Sherif Sundberg, Ralf BMJ Open Cardiovascular Medicine 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. BMJ Publishing Group 2016-06-02 /pmc/articles/PMC4908872/ /pubmed/27292972 http://dx.doi.org/10.1136/bmjopen-2015-010401 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Cardiovascular Medicine
Ravnskov, Uffe
Diamond, David M
Hama, Rokura
Hamazaki, Tomohito
Hammarskjöld, Björn
Hynes, Niamh
Kendrick, Malcolm
Langsjoen, Peter H
Malhotra, Aseem
Mascitelli, Luca
McCully, Kilmer S
Ogushi, Yoichi
Okuyama, Harumi
Rosch, Paul J
Schersten, Tore
Sultan, Sherif
Sundberg, Ralf
Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
title Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
title_full Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
title_fullStr Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
title_full_unstemmed Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
title_short Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
title_sort lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908872/
https://www.ncbi.nlm.nih.gov/pubmed/27292972
http://dx.doi.org/10.1136/bmjopen-2015-010401
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