Prospective Association Between Low and High Total and Low-Density Lipoprotein Cholesterol and Coronary Heart Disease in Elderly Men

Authors

  • J. David Curb MD,

    1. From the *Honolulu Heart Program, Kuakini Medical Center, Honolulu, HawaiiPacific Health Research Institute, Honolulu, HawaiiDepartments of Geriatric and Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii§Division of Biostatistics and Epidemiology, School of Medicine, University of Virginia, Charlottesville, Virginia.
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  • Robert D. Abbott PhD,

    1. From the *Honolulu Heart Program, Kuakini Medical Center, Honolulu, HawaiiPacific Health Research Institute, Honolulu, HawaiiDepartments of Geriatric and Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii§Division of Biostatistics and Epidemiology, School of Medicine, University of Virginia, Charlottesville, Virginia.
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  • Beatriz L. Rodriguez MD, PhD,

    1. From the *Honolulu Heart Program, Kuakini Medical Center, Honolulu, HawaiiPacific Health Research Institute, Honolulu, HawaiiDepartments of Geriatric and Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii§Division of Biostatistics and Epidemiology, School of Medicine, University of Virginia, Charlottesville, Virginia.
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  • Kamal Masaki MD,

    1. From the *Honolulu Heart Program, Kuakini Medical Center, Honolulu, HawaiiPacific Health Research Institute, Honolulu, HawaiiDepartments of Geriatric and Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii§Division of Biostatistics and Epidemiology, School of Medicine, University of Virginia, Charlottesville, Virginia.
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  • Jordan Popper MD,

    1. From the *Honolulu Heart Program, Kuakini Medical Center, Honolulu, HawaiiPacific Health Research Institute, Honolulu, HawaiiDepartments of Geriatric and Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii§Division of Biostatistics and Epidemiology, School of Medicine, University of Virginia, Charlottesville, Virginia.
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  • Randi Chen MS,

    1. From the *Honolulu Heart Program, Kuakini Medical Center, Honolulu, HawaiiPacific Health Research Institute, Honolulu, HawaiiDepartments of Geriatric and Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii§Division of Biostatistics and Epidemiology, School of Medicine, University of Virginia, Charlottesville, Virginia.
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  • Helen Petrovitch MD,

    1. From the *Honolulu Heart Program, Kuakini Medical Center, Honolulu, HawaiiPacific Health Research Institute, Honolulu, HawaiiDepartments of Geriatric and Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii§Division of Biostatistics and Epidemiology, School of Medicine, University of Virginia, Charlottesville, Virginia.
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  • Patricia Blanchette MD, MPH,

    1. From the *Honolulu Heart Program, Kuakini Medical Center, Honolulu, HawaiiPacific Health Research Institute, Honolulu, HawaiiDepartments of Geriatric and Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii§Division of Biostatistics and Epidemiology, School of Medicine, University of Virginia, Charlottesville, Virginia.
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  • Irwin Schatz MD,

    1. From the *Honolulu Heart Program, Kuakini Medical Center, Honolulu, HawaiiPacific Health Research Institute, Honolulu, HawaiiDepartments of Geriatric and Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii§Division of Biostatistics and Epidemiology, School of Medicine, University of Virginia, Charlottesville, Virginia.
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  • Katsuhiko Yano MD

    1. From the *Honolulu Heart Program, Kuakini Medical Center, Honolulu, HawaiiPacific Health Research Institute, Honolulu, HawaiiDepartments of Geriatric and Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii§Division of Biostatistics and Epidemiology, School of Medicine, University of Virginia, Charlottesville, Virginia.
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  • Funded by National Institutes of Health Awards NO1-HC-05102 and UO1-HL56274 (The Honolulu Heart Program).

J. David Curb, MD, Pacific Health Research Institute, 846 South Hotel Street, Suite 301, Honolulu, HI 96813. E-mail: jdcurb@phrihawaii.org

Abstract

Objectives: To examine the relationship between total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) and the incidence of coronary heart disease (CHD) in elderly men.

Design: Prospective.

Setting: Population based.

Participants: A sample of 2,424, Japanese-American men aged 71 to 93 was used.

Measurements: Six years of data on incident fatal plus nonfatal CHD were examined.

Results: Analysis revealed a significant U-shaped relationship between age-adjusted CHD rates and both TC and LDL-C. The ranges of TC and LDL-C with the lowest risk of CHD were 200 to 219 mg/dL and 120 to 139 mg/dL, respectively. As cholesterol concentrations declined and increased beyond these ranges, the risk of CHD increased. These U-shaped relationships remained significant after adjusting for age and other risk factors.

Conclusion: The U-shaped associations between TC and LDL-C and CHD imply a complex relationship between lipids and CHD in late life. The results indicate that elevated lipid levels should continue to be treated in healthy elderly individuals, as they are in those who are younger, although pharmacologically lowering lipids to excessively low levels in the elderly may warrant further study, as does the contribution of subclinical frailty to the relationship of lipids to CHD risk.

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