- Men aged 70 years or more with low total and low-density lipoprotein cholesterol (LDL-C) and not taking statins have increased risk for major adverse cardiovascular (CV) events (MACE) and mortality.
- These authors call the finding a paradox.
Why this matters
- Low cholesterol has previously been linked to worse outcomes in older people, but these authors stratified patients by whether or not they used statins.
- The increased risk was not seen among those taking statins.
- As total cholesterol decreased among men not taking statins, outcomes worsened significantly.
- For each 1 mmol/L decrease, adjusted HRs (95% CIs):
- MACE: 1.27 (1.10-1.45; P=.001).
- Mortality: 1.22 (1.03-1.44; P=.02).
- Risks with each 1 mmol/L decrease in LDL-C were slightly higher:
- MACE: 1.32 (1.13-1.55; P=.001).
- Mortality: 1.32 (1.09-1.59; P=.004).
- These associations were not seen for men with low cholesterol taking statins.
- The men taking statins had worse overall health but were slightly younger (76.5±5.1 vs 77.4±5.8 years; P=.003).
- Prospective cohort study, 1289 men (558 on statins; 731 not) aged 70 years or more.
- Funding: National Health and Medical Research Council, Australia; others.
- Observational, does not show causation.
- All men.