High blood cholesterol in elderly men and the excess risk for coronary heart disease.

OBJECTIVE To determine whether high blood cholesterol is an important risk factor for mortality from coronary heart disease in elderly men. DESIGN Cohort study with a mean follow-up of 10.1 years. SETTING A health maintenance organization. PATIENTS The cohort included 2746 white men 60 to 79 years of age who had no self-reported history of coronary heart disease. MEASUREMENT AND MAIN RESULTS A total of 260 deaths occurred during 27,842 person-years of follow-up. The relative risk for mortality from coronary heart disease in men 60 to 79 years of age in the highest serum cholesterol quartile was 1.5 (95% CI, 1.2 to 2.0) compared with those in the three lower quartiles combined. The relative risk did not change greatly with age, ranging from 1.4 in men 60 to 64 years of age to 1.7 in men 75 to 79 years of age. However, because mortality from coronary heart disease increased with age, the excess risk for such mortality attributable to elevated serum cholesterol levels increased fivefold over these 20 years, from 2.2 deaths per 1000 person-years to 11.3 deaths per 1000 person-years. CONCLUSIONS Our results support those of other observational studies in elderly men. If treatment of high blood cholesterol is as effective in reducing cholesterol-related risk for coronary heart disease after 65 years of age as it is in middle-aged men, it might actually produce greater reductions in mortality due to coronary heart disease. A clinical trial is needed to confirm this extrapolation.

[1]  D. Malenka,et al.  Cholesterol and coronary heart disease. The attributable risk reduction of diet and drugs. , 1989, Archives of internal medicine.

[2]  D. Reed,et al.  Is elevated serum cholesterol level a risk factor for coronary heart disease in the elderly? , 1990, JAMA.

[3]  T. Thom,et al.  Trends in CHD in the United States. , 1989, International journal of epidemiology.

[4]  J. Stamler,et al.  Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. , 1986, Journal of the American College of Cardiology.

[5]  R E Smith,et al.  The California Automated Mortality Linkage System (CAMLIS). , 1984, American journal of public health.

[6]  T. Welborn,et al.  Coronary Heart Disease Incidence and Cardiovascular Mortality in Busselton with Reference to Glucose and Insulin Concentrations , 1979, Diabetes Care.

[7]  S B Hulley,et al.  Overall and coronary heart disease mortality rates in relation to major risk factors in 325,348 men screened for the MRFIT. Multiple Risk Factor Intervention Trial. , 1986, American heart journal.

[8]  M C Hjortland,et al.  High density lipoprotein as a protective factor against coronary heart disease. The Framingham Study. , 1977, The American journal of medicine.

[9]  L. Kuller,et al.  SERUM CHOLESTEROL, BLOOD PRESSURE, AND MORTALITY: IMPLICATIONS FROM A COHORT OF 361 662 MEN , 1986, The Lancet.

[10]  W. Browner,et al.  Risk factor modification after myocardial infarction. , 1988, Annals of internal medicine.

[11]  W Young,et al.  Ischemic Heart Disease, Atherosclerosis, and Longevity , 1966, Circulation.

[12]  E. Agner,et al.  Fasting serum cholesterol and triglycerides in a ten-year prospective study in old age. , 2009, Acta medica Scandinavica.

[13]  L. Carlson,et al.  Ischaemic heart-disease in relation to fasting values of plasma triglycerides and cholesterol. Stockholm prospective study. , 1972, Lancet.

[14]  E. Agner.  Some cardiovascular risk markers are also important in old age. , 1985, Acta medica Scandinavica. Supplementum.

[15]  J. Huttunen,et al.  Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. , 1987, The New England journal of medicine.

[16]  D. Gordon,et al.  Treating high blood cholesterol in the older patient. , 1989, The American journal of cardiology.

[17]  M. Moser.  The Management of Cardiovascular Disease in the Elderly , 1982, Journal of the American Geriatrics Society.

[18]  D H Blankenhorn,et al.  Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts. , 1987, JAMA.

[19]  W. Kannel,et al.  Evaluation of cardiovascular risk in the elderly: the Framingham study. , 1978, Bulletin of the New York Academy of Medicine.

[20]  W. Kannel,et al.  Cholesterol in the prediction of atherosclerotic disease. New perspectives based on the Framingham study. , 1979, Annals of internal medicine.

[21]  L. Kuller,et al.  Predictors of cardiovascular events and mortality in the Systolic Hypertension in the Elderly Program pilot project. , 1987, American journal of epidemiology.

[22]  C. Furberg,et al.  Effect of long-term prophylactic treatment on survival after myocardial infarction. , 1984, The American journal of medicine.

[23]  Daniel Steinberg,et al.  Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. The Expert Panel. , 1988, Archives of internal medicine.

[24]  J. M. Chapman,et al.  THE INTERRELATIONSHIP OF SERUM CHOLESTEROL, HYPERTENSION, BODY WEIGHT, AND RISK OF CORONARY DISEASE. RESULTS OF THE FIRST TEN YEARS' FOLLOW-UP IN THE LOS ANGELES HEART STUDY. , 1964, Journal of chronic diseases.

[25]  E. Barrett-Connor,et al.  Ischemic heart disease risk factors after age 50. , 1984, Journal of chronic diseases.

[26]  W. Kannel,et al.  Proportional Hazards Analysis of Risk Factors for Coronary Heart Disease in Individuals Aged 65 or Older , 1988, Journal of the American Geriatrics Society.

[27]  D. Malenka,et al.  Cholesterol and coronary heart disease. The importance of patient-specific attributable risk. , 1988, Archives of internal medicine.

[28]  B. Littenberg,et al.  Screening asymptomatic adults for cardiac risk factors: the serum cholesterol level. , 1989, Annals of internal medicine.