Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
Ravnskov U, Diamond DM, Hama R, Hamazaki T, Hammarskjöld B, Hynes N, Kendrick M, Langsjoen PH, Malhotra A, Mascitelli L, McCully KS, Ogushi Y, Okuyama H, Rosch PJ, Schersten T, Sultan S, Sundberg R
BMJ open · 224 citas
Cómo se estudió
- Diseño
- Revisión sistemática (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación independiente
Según la declaración de financiación del texto completo.
Publicación
- Publicado
- 2016-06-01 · BMJ Open · vol. 6 · número 6 · pág. e010401
- Editorial
- BMJ
- Citado
- 343 citas · más que el 100% de estudios similares · 9.2× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 42 trabajos
- Acceso
- Acceso abierto (revista) · CC-BY-NC
- Áreas de investigación
- Lipoproteins and Cardiovascular Health · Cholesterol and Lipid Metabolism · Diabetes, Cardiovascular Risks, and Lipoproteins
- Palabras clave
- LDL cholesterol, older adults, all-cause mortality, cardiovascular mortality, cholesterol hypothesis, inverse association, LDL-C lowering therapy, cardiovascular disease prevention
- MeSH
- humans, cardiovascular diseases, mortality, risk factors, aged, middle aged, cholesterol, ldl
17 autores
- Uffe Ravnskov🇸🇪 · autor de correspondenciaMagle (Sweden)
- David M. Diamond🇺🇸University of South Florida
- Rokura Hama
- Tomohito Hamazaki🇯🇵University of Toyama
- Björn Hammarskjöld🇸🇪Strömstad Akademi
- Niamh Hynes🇮🇪National University of Ireland; University Hospital Galway; Galway Clinic
- Malcolm E Kendrick🇬🇧East Cheshire NHS Trust; Macclesfield District General Hospital
- Peter H. Langsjoen
- Aseem Malhotra🇬🇧Frimley Park Hospital
- Luca Mascitelli
- Kilmer S McCully🇺🇸Harvard University; VA Boston Healthcare System
- Yoichi Ogushi🇯🇵Tokai University
- Harumi Okuyama🇯🇵Kinjo Gakuin University; Nagoya City University
- PAUL J. ROSCH🇺🇸New York Medical College
- Tore Scherstén🇸🇪University of Gothenburg
- Sherif Sultan🇮🇪National University of Ireland; University Hospital Galway; Galway Clinic
- Ralf Sundberg
Resumen
El texto original del estudio, en el idioma en que se publicó.
Objective
It is well known that total cholesterol becomes less of a risk factor or not at all for all-cause and cardiovascular (CV) mortality with increasing age, but as little is known as to whether low-density lipoprotein cholesterol (LDL-C), one component of total cholesterol, is associated with mortality in the elderly, we decided to investigate this issue.
Setting, participants and outcome measures
We sought PubMed for cohort studies, where LDL-C had been investigated as a risk factor for all-cause and/or CV mortality in individuals ≥60 years from the general population.
Results
We identified 19 cohort studies including 30 cohorts with a total of 68 094 elderly people, where all-cause mortality was recorded in 28 cohorts and CV mortality in 9 cohorts. Inverse association between all-cause mortality and LDL-C was seen in 16 cohorts (in 14 with statistical significance) representing 92% of the number of participants, where this association was recorded. In the rest, no association was found. In two cohorts, CV mortality was highest in the lowest LDL-C quartile and with statistical significance; in seven cohorts, no association was found.
Conclusions
High LDL-C is inversely associated with mortality in most people over 60 years. This finding is inconsistent with the cholesterol hypothesis (ie, that cholesterol, particularly LDL-C, is inherently atherogenic). Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis. Moreover, our study provides the rationale for a re-evaluation of guidelines recommending pharmacological reduction of LDL-C in the elderly as a component of cardiovascular disease prevention strategies.
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