Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review.
Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review.
复制标题
DOI：
10.1136/bmjopen-2015-010401
复制
发表时间：
2016-06-12
期刊：
影响因子：
2.9
通讯作者：
Sundberg R
中科院分区：
文献类型：
--
作者：
Ravnskov U;Diamond DM;Hama R;Hamazaki T;Hammarskjöld B;Hynes N;Kendrick M;Langsjoen PH;Malhotra A;Mascitelli L;McCully KS;Ogushi Y;Okuyama H;Rosch PJ;Schersten T;Sultan S;Sundberg R
众所周知，随着年龄的增长，总胆固醇对全因死亡率和心血管 (CV) 死亡率的危险因素逐渐减少或根本不再是危险因素，但由于总胆固醇的一种成分低密度脂蛋白胆固醇 (LDL-C) 是否与老年人的死亡率相关，人们知之甚少，因此我们决定研究这个问题。我们寻求 PubMed 进行队列研究，其中 LDL-C 已被调查为普通人群 60 岁以上个体全因和/或心血管死亡率的危险因素。我们确定了 19 项队列研究，包括 30 个队列，总共 68 094 名老年人，其中 28 个队列记录了全因死亡率，9 个队列记录了心血管死亡率。全因死亡率与 LDL-C 之间呈负相关，在 16 个队列中（其中 14 个具有统计学显着性）观察到，占参与者人数的 92%，记录了这种相关性。其余的，没有发现任何关联。在两个队列中，心血管死亡率在最低 LDL-C 四分位数中最高，且具有统计学意义；在七个队列中，没有发现关联。对于大多数 60 岁以上的人来说，高 LDL-C 与死亡率呈负相关。这一发现与胆固醇假说不一致（即胆固醇，特别是低密度脂蛋白胆固醇，本质上是致动脉粥样硬化的）。由于 LDL-C 高的老年人的寿命与 LDL-C 低的老年人一样长，甚至更长，因此我们的分析为质疑胆固醇假说的有效性提供了理由。此外，我们的研究为重新评估建议将药物降低老年人 LDL-C 作为心血管疾病预防策略的组成部分的指南提供了依据。
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. 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. 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. 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.