PT - JOURNAL ARTICLE AU - Uffe Ravnskov AU - David M Diamond AU - Rokura Hama AU - Tomohito Hamazaki AU - Björn Hammarskjöld AU - Niamh Hynes AU - Malcolm Kendrick AU - Peter H Langsjoen AU - Aseem Malhotra AU - Luca Mascitelli AU - Kilmer S McCully AU - Yoichi Ogushi AU - Harumi Okuyama AU - Paul J Rosch AU - Tore Schersten AU - Sherif Sultan AU - Ralf Sundberg TI - Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review AID - 10.1136/bmjopen-2015-010401 DP - 2016 Jun 01 TA - BMJ Open PG - e010401 VI - 6 IP - 6 4099 - http://bmjopen.bmj.com/content/6/6/e010401.short 4100 - http://bmjopen.bmj.com/content/6/6/e010401.full SO - BMJ Open2016 Jun 01; 6 AB - 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.