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Robert Clarke, FRCP; Jonathan R. Emberson, PhD; Sarah Parish, DPhil; Alison Palmer, MSc; Martin Shipley, MSc; Pamela Linksted, MSc; Paul Sherliker, BSc; Sarah Clark, DPhil; Jane Armitage, FRCP, FFPHM; Astrid Fletcher, PhD; Rory Collins, FRCP

Arch Intern Med. 2007;167(13):1373-1378.

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 A₁ 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 A₁ 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 A₁ 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.

Author Affiliations: Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford (Drs Clarke, Emberson, Parish, Clark, Armitage, and Collins; Mss Palmer and Linksted; and Mr Sherliker), and Department of Epidemiology and Public Health, University College London Medical School (Mr Shipley), and Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (Dr Fletcher), London, England.
Deceased.

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