Original Study
Cholesterol, Statins, and Longevity From Age 70 to 90 Years

https://doi.org/10.1016/j.jamda.2013.08.012Get rights and content

Abstract

Background

The importance of cholesterol as a risk factor among older people, particularly among the very old, is controversial. Whether or not hypercholesterolemia warrants medical concern, and whether statins are beneficial among very old people, remain unresolved common clinical dilemmas. This study examines whether increased total cholesterol (TC) was associated with higher mortality from age 70 to 90, and if statins had a protective effect.

Methods

A representative sample (born 1920–1921) from the Jerusalem Longitudinal Cohort Study (1990–2010) was assessed at ages 70, 78, and 85 for fasting serum TC, low-density (LDL), and high-density lipoprotein (LDL); triglycerides; statin usage; social, functional, and medical domains; and all-cause mortality data (1990–2010). TC was analyzed as either continuous (10 mg/dL increments) or dichotomous variable (high TC >200 mg/dL). Cox proportional hazards models determined mortality hazard ratios (HRs), adjusting for TC, statin treatment, gender, self-rated health, smoking, hypertension, diabetes, ischemic heart disease, neoplasm, body mass index, albumin, and triglycerides.

Results

Prevalence of high TC at ages 70, 78, and 85 was 75% (n = 344), 65% (n = 332), and 34% (n = 237), and statin use was 0%, 17.9%, and 45.4%, respectively. Survival was increased (not significantly) among subjects with high TC >200 mg/dL versus ≤200 mg/dL from ages 70 to 78, 78 to 85, and 85 to 90: 79.1% versus 73.3% (log rank P = .16), 68.7% versus 61.5% (P = .10), and 73.4% versus 70.3% (P = .45), respectively. Survival was significantly increased among subjects treated with statins versus no statins at ages 78 to 85 (74.7% vs 64.3%, log rank P = .07) and 85 to 90 (76.2% vs 67.4%, P = .01). After adjustment, TC (continuous or dichotomous) was not associated with mortality from 70 to 78, 78 to 85, or 85 to 90. In contrast, statins at age 85 were associated with decreased mortality from age 85 to 90 (adjusted HR 0.61, 95% confidence interval 0.42–0.89).

Conclusions

Among older people, cholesterol levels were unrelated to mortality between the ages of 70 and 90. The protective effect of statins observed among the very old appears to be independent of TC.

Section snippets

Study Sample

The Jerusalem Longitudinal Study has prospectively followed a birth cohort of Jerusalem residents (born June 1920 to May 1921) from age 70 at baseline in 1990 until the present time. A detailed description of study methodology has been described previously.6, 7, 8 Individuals in the baseline study sample were examined at age 70 in 1990, with subsequent study waves performed on the same study samples at ages 78 (1998) and 85 (2005). The original study sample, which formed about one-third of the

Results

The study examines data from 460, 512, and 702 participants, aged 70, 78, and 85, respectively, among whom the prevalence of high TC (>200 mg/dL) was 75% (n = 344), 65% (n = 332), and 34% (n = 237), respectively. Baseline characteristics are shown in Table 1. At age 70, before statins had been locally introduced into clinical use, high TC was associated with being female, not being married, chronic pain, and cerebrovascular disease. At age 78, participants with high TC had lower rates of IHD,

Discussion

TC levels at age 70, 78, or 85 years were not significantly associated with increased all-cause mortality in this prospective observational study of a representative sample of community-dwelling people. Although there was a consistent trend toward improved survival among participants with higher TC, it was not statistically significant in either the Kaplan-Meier or Cox proportional hazards analyses, when measured as a dichotomous or continuous variable. It should be noted that the absence of

Acknowledgments

We are grateful to all the people who participated in the study.

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    This study was funded by the Ministry of Senior Citizens, the Ministry of Labor and Social Affairs of the State of Israel, the National Insurance Institute, and Eshel–the Association for the Planning and Development of Services for the Aged in Israel. No support was offered by any commercial venture. These funds were used exclusively to support the research effort, primarily as salaries to ancillary staff. No research funds were received by any author of this article.

    The sponsors had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review, or approval of the manuscript.

    The authors declare no conflicts of interest.

    JS, JMJ, AC, and EEM had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Author contributions: Study concept and design: JS, JMJ, AC. Acquisition of data: JS, JMJ, AC, EEM. Analysis and interpretation of data: JMJ, JS, EEM, AC. Drafting of the first manuscript and critical revision of the manuscript for important intellectual content: JMJ, JS, EEM, AC. Statistical analyses: EEM, JS, JMJ, AC. Administrative, technical, or material support: JS. Obtained funding, study supervision: JS.

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