Abstract
BackgroundLife expectancy has greatly increased, generating an improvement in screening programs for disease prevention, lifesaving drugs and medical devices. The impact of lowering low-density lipoprotein cholesterol (LDL-C) in the very elderly is not well-established. Our aim was to explore the association of LDL-C, high density lipoprotein cholesterol (HDL-C) and lipid lowering drugs (LLDs) on cognitive decline, malignancies and overall survival.MethodsThis was a retrospective cohort study. Our study comprised 1498 (72.7%) males and 561 (27.3%) females, aged ≥70 who had attended the Institute for Medical Screening (IMS), Sheba Medical Center, Israel at least twice during 2013–2019. Data were obtained from the computerized database of the IMS. A manual quality control to identify potential discrepancies was performed.ResultsOverall, 6.3% of the subjects treated with LLDs (95/1421) versus 4.2% not treated (28/638), cognitively declined during the study years. No statistically significant effects of LDL-C, HDL-C and LLDs on cognitive decline were observed after correcting for age, prior stroke and other vascular risk factors. With regard to cancer, after adjusting for confounders and multiple inferences, no definite relationships were found.ConclusionsThis analysis of an elderly, high socioeconomic status cohort suggests several relationships between the use of LLDs and health outcomes, some beneficial, especially, with regard to certain types of cancer, but with a higher risk of cognitive decline. Further studies are warranted to clarify the health effects of these medications in the elderly.
Highlights
Life expectancy has greatly increased, generating an improvement in screening programs for disease prevention, lifesaving drugs and medical devices
We investigated the potential association of lipid profile, treatment with lipid lowering drugs (LLDs) and morbidity of older individuals with a high socio-economic status (SES)
When analyzing the association between high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), TG, LLDs treatment and cancer, we found some effects on hazard, none were strong enough to pass our false discovery rate (FDR) filter
Summary
Life expectancy has greatly increased, generating an improvement in screening programs for disease prevention, lifesaving drugs and medical devices. Our aim was to explore the association of LDL-C, high density lipoprotein cholesterol (HDL-C) and lipid lowering drugs (LLDs) on cognitive decline, malignancies and overall survival. Increased low-density lipoprotein cholesterol (LDL-C), an established risk factor for cardiovascular disease (CVD), is often treated by lipid lowering drugs (LLDs) to prevent cardiovascular events. There is a subset of elderly people with high LDL-C who live longer than those with low levels [4]. Another potential beneficial effect of increased LDL-C is the inactivation of microorganisms which may explain the reduced mortality from respiratory and gastrointestinal diseases [5, 6]. High LDL-C may play a protective role against cancer, as witnessed by lower cancer mortality in patients with familial hypercholesterolemia
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