Title |
Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
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Published in |
BMJ Open, June 2016
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DOI | 10.1136/bmjopen-2015-010401 |
Pubmed ID | |
Authors |
Uffe Ravnskov, David M Diamond, Rokura Hama, Tomohito Hamazaki, Björn Hammarskjöld, Niamh Hynes, Malcolm Kendrick, Peter H Langsjoen, Aseem Malhotra, Luca Mascitelli, Kilmer S McCully, Yoichi Ogushi, Harumi Okuyama, Paul J Rosch, Tore Schersten, Sherif Sultan, Ralf Sundberg |
Abstract |
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. |
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Scientists | 89 | 5% |
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Mendeley readers
Geographical breakdown
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Australia | 2 | <1% |
Netherlands | 1 | <1% |
Italy | 1 | <1% |
Portugal | 1 | <1% |
United Kingdom | 1 | <1% |
Peru | 1 | <1% |
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Other | 75 | 13% |
Student > Master | 70 | 13% |
Researcher | 65 | 12% |
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Unknown | 107 | 19% |
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Unknown | 131 | 23% |