ODP138 Age-related Associations of LDL Cholesterol and Atherosclerotic Cardiovascular Disease: A Nationwide Population-based Cohort Study

BACKGROUND: No completed randomized trial exclusively incorporating the elderly has addressed the benefit of statin treatment for primary prevention until now. Therefore, consensus of major international lipid management guidelines has not been made upon lowering LDL cholesterol (LDL-C)to prevent primary atherosclerotic cardiovascular disease (ASCVD)in the older population. Question: This study aimed to investigate whether ASCVD risk according to increasing LDL-C differs between age groups. METHODS: Data was provided by the Health Screening Cohort of the Korean National Health Insurance Service, which is a nationwide health screening program covering the whole population with alow attrition rate. Subjects with preexisting cardiovascular disease or taking lipid-lowering drugs were excluded. Participants were followed up from January1,2011 to December31, 2015. Multivariable Cox proportional hazard regressions were performed to evaluate the relationship between LDL-C and ASCVD. Subgroup analyses were also conducted in patients with T2DM. RESULTS: The final cohort was composed of 285,119 participants with a mean age of 58.4 years and 55.2% of men. The average baseline LDL-C level was 121.5 mg/dL (standard deviation, 36.4). The proportion of individuals was 2.4% (n =6,718),9. 0% (n = 25,687), 26.6% (n = 75,981), 37.2% (n = 105,952), 20.2% (n = 57,562), and 4.6% (n = 13,219) in LDL-C ≥190, 160–189, 130–159, 100–129, 70–99, and<70 mg/dL, respectively. Patients with T2DM comprised 7.5% (n = 21,258) of the entire population. During a median follow-up of 6.44 years, the first ASCVD developed in8,996 participants (3.2%). All age groups showed positive associations between LDL-C and ASCVD risk, mostly with statistical significance from LDL-C of 160 mg/dL onward. ASCVD risk did not differ significantly between the age groups (P for interaction =0.62). Compared with ASCVD risk in LDL-C of 70–99 mg/dL, the risk in the highest LDL-C(≥190 mg/dL)was similar between groupsaged<50 and ≥70 years (adjusted hazard ratio [aHR], 1.90 [95%confidence interval (CI),1.52–2.38] and aHR, 1.86 [95% CI, 1.30–2.68], respectively). Subgroup analysis in patients with T2DM showed that 7.2% of subjects experienced incident ASCVD. Age-specific association of ASCVD risk and LDL-C in T2DM patients displayed no difference in line with the total participants(P for interaction = 0.31). CONCLUSIONS: A large-scale, population-based cohort study of adults who had no previous CVD history and were not prescribed lipid-lowering drugs demonstrated that elevated LDL-C was significantly correlated with a greater risk of ASCVD in people aged≥70 years, which was comparable with the risk in younger adults. This finding spotlights the necessity of settling intensive guidance on LDL-C levels for primary CVD prevention in the elderly. Presentation: No date and time listed