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Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
  1. Uffe Ravnskov1,
  2. David M Diamond2,
  3. Rokura Hama3,
  4. Tomohito Hamazaki4,
  5. Björn Hammarskjöld5,
  6. Niamh Hynes6,
  7. Malcolm Kendrick7,
  8. Peter H Langsjoen8,
  9. Aseem Malhotra9,
  10. Luca Mascitelli10,
  11. Kilmer S McCully11,
  12. Yoichi Ogushi12,
  13. Harumi Okuyama13,
  14. Paul J Rosch14,
  15. Tore Schersten15,
  16. Sherif Sultan6,
  17. Ralf Sundberg16
  1. 1Magle Stora Kyrkogata 9, 22350 Lund, Sweden
  2. 2Department of Psychology, Department of Molecular Pharmacology and Physiology, Center for Preclinical and Clinical Research on PTSD, University of South Florida, Tampa, Florida, USA
  3. 3NPO Japan Institute of Pharmacovigilance, Osaka, Japan
  4. 4Department of Internal Medicine, Toyama Jonan Onsen Daini Hospital, University of Toyama, Toyama City, Japan
  5. 5Strömstad Academy, Strömstad, Sweden
  6. 6Western Vascular Institute, University Hospital Galway & Galway Clinic, National University of Ireland & Royal college of Surgeons of Ireland affiliated Hospital, Galway, Ireland
  7. 7East Cheshire Trust, Macclesfield District General Hospital, Macclesfield, Cheshire, England
  8. 8Solo Practice in Cardiology, Tyler, Texas 75701, USA
  9. 9Department of cardiology, Frimley Park Hospital, Portsmouth road, Surrey GU16 7UJ, UK
  10. 10Medical Service, Comando Brigata Alpina “Julia”/Multinational Land Force, Udine, Italy
  11. 11Pathology and Laboratory Medicine Service, VA Boston Healthcare System, West Roxbury; Harvard Medical School, Boston, Massachusetts
  12. 12Tokai University, Daikancho, Hiratsuka, Kanagawa, Japan 254-0807
  13. 13Nagoya City University and Institute for Consumer Science and Human Life, Kinjo Gakuin University, Nagoya, Japan
  14. 14New York Medical College; The American Institute of Stress
  15. 15Sahlgren's Academy, University of Gothenburg, Sweden, and Colombia University, NY, USA
  16. 16Slottsstadens Läkarhus, Malmö, Gothenburg, Sweden
  1. Correspondence to Dr Uffe Ravnskov; ravnskov{at}


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.

  • Risk factor, LDL-cholesterol, cardiovascular mortality, total mortality, elderly,

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