Abstract
Background and aimsPrevious studies have indicated that the association of elevated low-density lipoprotein cholesterol (LDL-C) with cardiovascular disease (CVD) varies greatly with age, with the association being much stronger in younger than older individuals. To estimate the relationship between LDL-C and CVD risk in a contemporary population aged over 70 years in China. Methods and resultsIn this analysis, participants of China Health and Retirement Longitudinal Study (CHARLS) who did not take statins and did not have heart disease and stroke in 2011 were include and were followed up to 2018. The outcome of this analysis was the occurrence of CVD. Cox regression was used to assess the effect of LDL-C on CVD. We calculated E-values to quantify the effect of unmeasured confounding. In the 9,631 participants, 15.2% (N = 1,463) were aged over 70 years. During follow-up of 7 years, 1,437 participants had a first CVD attack. The Risk of CVD increased with each 10 mg/mL elevation in LDL-C in whole participants and all age groups. We noted a U-shaped relationship between LDL-C and risk of CVD in group over 70 years old, however, we further found that in the left side of U-shape curve, LDL-C was not associated with CVD, which indicated that a lower level of LDL-C could not increase the risk of CVD. E-value analysis suggested robustness to unmeasured confounding. ConclusionsIn a contemporary society of China, elevated the level of LDL-C also increased the risk of CVD in participants over 70 years old. These results should strengthen guideline recommendations for the use of lipid-lowering therapies in those elderly.
Highlights
A large number of epidemiological and clinical studies indicate that arteriosclerotic cardiovascular disease (ASCVD) is currently the leading fatal and disabling disease that endangers human health
Risk of CVD occurrence increased 8% with each 10 mg/mL elevation in low density lipoprotein cholesterol (LDL-C) in whole participants and age groups of ≥70 years, 60-69years and
Similar results were observed in subgroup analyses, in which participants were stratified by sex, hypertension, diabetes and chronic kidney disease
Summary
A large number of epidemiological and clinical studies indicate that arteriosclerotic cardiovascular disease (ASCVD) is currently the leading fatal and disabling disease that endangers human health. [7,8,9] In some studies, the association of increased cholesterol with clinical events even disappeared in individuals over 70 years. [17,18] whether LDL-C is associated with increased risk of CVD occurrence in people over 70 years old in China is deserved to investigated. A most recent study performed in Copenhagen General Population has demonstrated that higher LDL-C is associated with greatly increased absolute risk of myocardial infarction in people aged 70-100 years, which provided the basis for us to perform this analysis. In which the data were collected about half a century ago, suggested that elevated low density lipoprotein cholesterol (LDL-C) is not associated with increased risk of cardiovascular disease (CVD) in patients over 70 years old. What is the relationship between LDL-C and CVD risk in a contemporary population aged over 70 years has not been well examined in China
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