Association between lipoprotein cholesterol and future cardiovascular disease and mortality in older adults: a Korean nationwide longitudinal study

Seung Hee Kim,Ki Young Son

doi:10.1186/s12944-020-01426-0

Abstract

BackgroundDyslipidemia is considered an independent health risk factor of cardiovascular disease (CVD), a leading cause of mortality in older adults. Despite its importance, there have been few reports on the association between lipoprotein cholesterol and future CVD and cardiovascular (CV) mortality among elderly Asians aged ≥ 65 years. This study investigated the association between lipoprotein cholesterol and future CVD and CV mortality in an elderly Korean population using a large nationwide sample.MethodsFrom the cohort database of the Korean National Health Insurance Service, 62,604 adults aged ≥ 65 years (32,584 men and 30,020 women) were included. High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were categorized by quartiles. Cox proportional hazard models and linear regression analyses were used to assess the association between the quartiles of lipoprotein cholesterol and future CV events or mortality.ResultsThe mean follow-up period was 3.3 years. The incidence rates of ischemic heart disease and ischemic brain disease were 0.97 and 0.61 per 1,000 person-years, respectively, and the mortality rates from these diseases were 0.22 and 0.34 per 1,000 person-years, respectively. In a completely adjusted model, high HDL-C and LDL-C levels were not associated with total CV events and CVD mortality. However, high LDL-C levels were significantly associated with a lower incidence of ischemic brain disease. Furthermore, diabetic patients with high LDL-C levels were more likely to have higher CV mortality, whereas non-smokers with high LDL-C levels were less likely to be at risk of CV events.ConclusionsNeither high LDL-C nor HDL-C levels were significantly associated with future CV mortality in older adults aged ≥ 65 years. High LDL-C levels do not seem to be a risk factor for CVD in elderly individuals, and further studies are required.

Highlights

Dyslipidemia is considered an independent health risk factor of cardiovascular disease (CVD), a leading cause of mortality in older adults
This study examined the association between lipoprotein cholesterol and future CVD events and deaths using a nationwide large sample of an Asian country
High Low-density lipoprotein cholesterol (LDL-C) levels were significantly associated with a lower incidence of ischemic brain disease, they were not associated with ischemic heart disease events or CV death

Summary

Introduction

Dyslipidemia is considered an independent health risk factor of cardiovascular disease (CVD), a leading cause of mortality in older adults. There have been few reports on the association between lipoprotein cholesterol and future CVD and cardiovascular (CV) mortality among elderly Asians aged ≥ 65 years. This study investigated the association between lipoprotein cholesterol and future CVD and CV mortality in an elderly Korean population using a large nationwide sample. Dyslipidemia is considered an independent risk factor for CVD. Low-density lipoprotein cholesterol (LDL-C) has been reported as the most atherogenic lipoprotein, and an interventional study has shown that lowering LDL-C levels using statin therapy reduces CV events [3]. All CV guidelines highlight the evidence that LDL-C is a major cause of CVD and a primary target of lipid-lowering therapy [4]. Increase in high-density lipoprotein cholesterol (HDL-C) levels is not always associated with a positive effect, and the effect of lowering HDL-C levels is unclear [3]

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