Cholesterol fractions and apolipoproteins as risk factors for heart disease mortality in older men

Clarke, R; Emberson, JR; Parish, S; Palmer, A; Shipley, M; Linksted, P; Sherliker, P; Clark, S; Armitage, J; Fletcher, A; Collins, R; (2007) Cholesterol fractions and apolipoproteins as risk factors for heart disease mortality in older men. Archives of internal medicine, 167 (13). pp. 1373-1378. ISSN 0003-9926 DOI:

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Background: The relevance of blood lipid levels as risk factors for ischemic heart disease (IHD) in older people is uncertain; hence, cholesterol-lowering therapy is not routinely prescribed in older populations. Methods: We assessed IHD mortality associations with plasma levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein B, and apolipoprotein A(1) measured in older men. Ischemic heart disease was assessed in a 7-year follow-up of a cohort of 5344 men (mean age, 76.9 years), including 74.3% without cardiovascular disease (CVD) or statin use and 25.6% with CVD or statin use. Hazard ratios (HRs) for 447 deaths from IHD were estimated for a 2-SD difference in usual plasma lipid levels. Results: Ischemic heart disease mortality was not significantly associated with total cholesterol levels in all men (HR, 1.05), but a significant positive association in men without CVD and a slight nonsignificant inverse association in men with CVD were observed (HR, 1.47 vs 0.84). The patterns were similar for low-density lipoprotein cholesterol levels (HR, 1.50 vs 0.98) and for apolipoprotein B levels (HR, 1.68 vs 0.93). Ischemic heart disease risks were inversely associated with high-density lipoprotein cholesterol levels and with apolipoprotein A(1) levels in men with and without CVD. Ischemic heart disease risks were strongly associated with total-high-density lipoprotein cholesterol levels (HR, 1.57) and apolipoprotein B-apolipoprotien A(1) levels (HR, 1.54), and remained strongly related at all ages. Conclusions: Blood lipid levels other than total cholesterol levels were associated with IHD in older men. Differences in lipid levels that are achievable by statin use were associated with about a one-third lower risk of IHD, irrespective of age.

Item Type: Article
Keywords: Adult, Aged, Apolipoprotein A-I, blood, Apolipoproteins, blood, Heart Diseases, blood, mortality, prevention & control, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, therapeutic use, Lipoproteins, blood, Lipoproteins, HDL, blood, Lipoproteins, LDL, blood, Male, Middle Aged, Myocardial Ischemia, blood, Prospective Studies, Risk Factors, Survival Analysis
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
PubMed ID: 17620530
Web of Science ID: 247891500006


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