More CV events seen in men aged 70-plus years with low cholesterol

  • Gnanenthiran SR & al.
  • Heart
  • 13 Oct 2019

  • International Clinical Digest
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Takeaway

  • 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.

Key results

  • 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).

Study design

  • Prospective cohort study, 1289 men (558 on statins; 731 not) aged 70 years or more.
  • Funding: National Health and Medical Research Council, Australia; others.

Limitations

  • Observational, does not show causation.
  • All men.