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Low High-Density Lipoprotein Cholesterol a Risk Factor for Stroke in Elderly Patients

Dutch researchers report that low high-density lipoprotein (HDL) cholesterol is a risk factor for coronary artery disease-related or stroke-related death in patients older than 85 years.

They say HDL cholesterol but not total or low-density lipoprotein (LDL) cholesterol is associated with mortality in elderly people. Low HDL cholesterol in elderly people increases two- to threefold the risk of mortality from coronary artery disease and stroke.

"Furthermore, LDL and HDL cholesterol concentrations are inversely correlated with all-cause mortality, mainly because of lower mortality from infection," explain investigators led by Dr. Annelies Weverling-Rijnsburger, Leiden University Medical Centre, in Leiden, The Netherlands.

The researchers initiated a prospective follow-up of the 705 inhabitants of Leiden who reached age 85 years between September 1997 and September 1999. No criteria on health or demographic characteristics were used for enrolment. A total of 599 patients (87%) participated and were followed until September 2001. The group included 397 women and 202 men.

Serum levels for total, LDL, and HDL cholesterol were taken and electrocardiograms done at baseline. Medical information was obtained from participants' doctors, and data on drug use was obtained from computerised pharmacy registries.

Data on lipoproteins were available for 561 participants; lipid and lipoprotein levels could not be determined in 38 patients.

During the 4-year follow-up period, 152 of the 561 (27%) subjects died. Leading cause of death was cardiovascular disease. This meant that compared with the 705 subjects eligible for the study, the cumulative 4-year mortality risk of the 561 subjects was 0.9.

The researchers say the study results show that low levels of total, LDL, and HDL cholesterol are all associated with increased mortality risk, which puts in question the necessity of cholesterol-lowering therapy in the elderly.

They conclude, "The present study shows that people aged 85 years with high total or fractionated cholesterol levels have lower risk of mortality, because of their protective effects against death from infectious disease."

As well, low HDL cholesterol -- but not high LDL or high total cholesterol -- is a risk factor for fatal coronary artery disease and stroke in people older than 85 years.
Archives of Internal Medicine 2003;163:13:1549-1554. "High-Density vs Low-Density Lipoprotein Cholesterol as the Risk Factor for Coronary Artery Disease and Stroke in Old Age"

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