TY - JOUR

T1 - Lipid-lowering treatment to the end? A review of observational studies and RCTs on cholesterol and mortality in 80+-year olds

AU - Petersen, Line Kirkeby

AU - Christensen, Kaare

AU - Kragstrup, Jakob

N1 - Funding Information: The Danish Aging Research Center is supported by the VELUX foundation. The research was supported by the US National Institute on Aging, research grant NIA-P01-AG08761, and by a Danish grant from Savværksejer Jeppe Juhl og Hustru Ovita Juhls Mindelegat.

PY - 2010/11

Y1 - 2010/11

N2 - People aged 80 or older are the fastest growing population in high-income countries. One of the most common causes of death among the elderly is the cardiovascular disease (CVD). Lipid-lowering treatment is common, e.g. one-third of 75-84-year-old Swedes are treated with statins [3]. The assumption that hypercholesterolaemia is a risk factor at the highest ages seems to be based on extrapolation from younger adults. A review of observational studies shows a trend where all-cause mortality was highest when total cholesterol (TC) was lowest ('a reverse J-shaped' association between TC and all-cause mortality). Low TC (<5.5/mmol/l) is associated with the highest mortality rate in 80+-year olds. No clear optimal level of TC was identified. A review of the few randomised controlled trials including 80+-year olds did not provide evidence of an effect of lipid-lowering treatment on total mortality in 80+-year-old people. There is not sufficient data to recommend anything regarding initiation or continuation of lipid-lowering treatment for the population aged 80+, with known CVD, and it is even possible that statins may increase all-cause mortality in this group of elderly individuals without CVD.

AB - People aged 80 or older are the fastest growing population in high-income countries. One of the most common causes of death among the elderly is the cardiovascular disease (CVD). Lipid-lowering treatment is common, e.g. one-third of 75-84-year-old Swedes are treated with statins [3]. The assumption that hypercholesterolaemia is a risk factor at the highest ages seems to be based on extrapolation from younger adults. A review of observational studies shows a trend where all-cause mortality was highest when total cholesterol (TC) was lowest ('a reverse J-shaped' association between TC and all-cause mortality). Low TC (<5.5/mmol/l) is associated with the highest mortality rate in 80+-year olds. No clear optimal level of TC was identified. A review of the few randomised controlled trials including 80+-year olds did not provide evidence of an effect of lipid-lowering treatment on total mortality in 80+-year-old people. There is not sufficient data to recommend anything regarding initiation or continuation of lipid-lowering treatment for the population aged 80+, with known CVD, and it is even possible that statins may increase all-cause mortality in this group of elderly individuals without CVD.

KW - 80+-year olds

KW - Aged

KW - Cholesterol

KW - Elderly

KW - Lipid-lowering treatment and all-cause mortality

UR - http://www.scopus.com/inward/record.url?scp=77958577146&partnerID=8YFLogxK

U2 - 10.1093/ageing/afq129

DO - 10.1093/ageing/afq129

M3 - Review

C2 - 20952373

AN - SCOPUS:77958577146

VL - 39

SP - 674

EP - 680

JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

IS - 6

M1 - afq129

ER -