TY - JOUR
T1 - The Association Between Low-Density Lipoprotein Cholesterol and Incident Atherosclerotic Cardiovascular Disease in Older Adults
T2 - Results From the National Institutes of Health Pooled Cohorts
AU - Nanna, Michael G.
AU - Navar, Ann Marie
AU - Wojdyla, Daniel
AU - Peterson, Eric D.
N1 - Funding Information:
Dr Navar is funded by National Institutes of Health (NIH) K01HL133416‐01. Dr Nanna is supported by the NIH training grant T‐32‐HL069749‐15.
Funding Information:
We thank Erin Campbell, MS, for her editorial contributions to this article. Ms Campbell did not receive compensation for her contributions, apart from her employment at the institution where this study was conducted. Dr Navar is funded by National Institutes of Health (NIH) K01HL133416-01. Dr Nanna is supported by the NIH training grant T-32-HL069749-15. Nanna: No relationship(s) to disclose. Navar: Research grant: significant: Amarin, Janssen, Amgen, Sanofi, and Regeneron Pharmaceuticals. Consultant/advisory board: significant: Amarin, Amgen, NovoNordisk, AstraZeneca, Sanofi, and Regeneron. Wojdyla: No relationship(s) to disclose. Peterson: Research grant: significant: Amgen, Sanofi, Astrazeneca, and Merck. Consultant/advisory board: modest: Amgen. Consultant/advisory board: significant: AstraZeneca, Merck, and Sanofi Aventis. All authors have been involved in the study design, analysis, and manuscript revision. All authors read and approved the final manuscript. Dr Nanna is the guarantor who accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish. Nanna: Dr Nanna had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr Nanna contributed to the conception and design of the study, the data analysis, the data interpretation, the manuscript drafting, and the critical revision of the manuscript. Navar: Dr Navar contributed to the conception and design of the study, the supervision, the data acquisition, the data analysis, the data interpretation, the manuscript drafting, and the critical revision of the manuscript. Wojdyla: Mr Wojdyla contributed to the design of study, the data analysis, the data interpretation, the manuscript drafting, and the critical revision of the manuscript. Peterson: Dr Peterson contributed to the conception and design of the study, the supervision, the data acquisition, the data analysis, the data interpretation, the manuscript drafting, and the critical revision of the manuscript.
Publisher Copyright:
© 2019 The American Geriatrics Society
PY - 2019/12/1
Y1 - 2019/12/1
N2 - BACKGROUND/OBJECTIVES: Elevated low-density lipoprotein cholesterol (LDL-C) in early adulthood is associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). The strength of the association between LDL-C and ASCVD among older adults, however, is less understood. DESIGN: We examined individual-level cohort data from the National Institutes of Health Pooled Cohorts (Framingham Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Cardiovascular Health Study), which prospectively measured CVD risk factors and incident disease. SETTING: Prospective cohort study. PARTICIPANTS: Adults, aged 75 years or older, free of ASCVD. MEASUREMENTS: We evaluated the associations between LDL-C and incident ASCVD (stroke, myocardial infarction, and cardiovascular death) in unadjusted analysis and in multivariable-adjusted Cox proportional hazards models. We assessed 5-year Kaplan-Meier ASCVD event rates in patients with and without hyperlipidemia (LDL-C ≥130 mg/dL or on lipid-lowering medications), stratified by the number of other risk factors, including smoking, diabetes, and hypertension. RESULTS: We included 2667 adults, aged 75 years or older (59% female), free of ASCVD; median age was 78 years, with median LDL-C of 117 mg/dL. In both unadjusted and adjusted analyses, there was no association between LDL-C and ASCVD (adjusted hazard ratio = 1.022; 95% confidence interval = 0.998-1.046; P =.07). Among adults without other risk factors (free of smoking, diabetes, and hypertension), event rates were similar between those with and without hyperlipidemia (Kaplan-Meier rates = 5.8% and 7.0%, respectively). Among adults with one or two or more other risk factors, the presence of hyperlipidemia was also not associated with 5-year CVD event rates (Kaplan-Meier rates = 12.8% vs 15.0% [P =.44] for one other risk factor and 21.9% vs 24.0% [P =.59] for two or more other risk factors). CONCLUSION: Among a well-characterized cohort, LDL-C was not associated with CVD risk among adults aged 75 years or older, even in the presence of other risk factors. J Am Geriatr Soc 67:2560–2567, 2019.
AB - BACKGROUND/OBJECTIVES: Elevated low-density lipoprotein cholesterol (LDL-C) in early adulthood is associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). The strength of the association between LDL-C and ASCVD among older adults, however, is less understood. DESIGN: We examined individual-level cohort data from the National Institutes of Health Pooled Cohorts (Framingham Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Cardiovascular Health Study), which prospectively measured CVD risk factors and incident disease. SETTING: Prospective cohort study. PARTICIPANTS: Adults, aged 75 years or older, free of ASCVD. MEASUREMENTS: We evaluated the associations between LDL-C and incident ASCVD (stroke, myocardial infarction, and cardiovascular death) in unadjusted analysis and in multivariable-adjusted Cox proportional hazards models. We assessed 5-year Kaplan-Meier ASCVD event rates in patients with and without hyperlipidemia (LDL-C ≥130 mg/dL or on lipid-lowering medications), stratified by the number of other risk factors, including smoking, diabetes, and hypertension. RESULTS: We included 2667 adults, aged 75 years or older (59% female), free of ASCVD; median age was 78 years, with median LDL-C of 117 mg/dL. In both unadjusted and adjusted analyses, there was no association between LDL-C and ASCVD (adjusted hazard ratio = 1.022; 95% confidence interval = 0.998-1.046; P =.07). Among adults without other risk factors (free of smoking, diabetes, and hypertension), event rates were similar between those with and without hyperlipidemia (Kaplan-Meier rates = 5.8% and 7.0%, respectively). Among adults with one or two or more other risk factors, the presence of hyperlipidemia was also not associated with 5-year CVD event rates (Kaplan-Meier rates = 12.8% vs 15.0% [P =.44] for one other risk factor and 21.9% vs 24.0% [P =.59] for two or more other risk factors). CONCLUSION: Among a well-characterized cohort, LDL-C was not associated with CVD risk among adults aged 75 years or older, even in the presence of other risk factors. J Am Geriatr Soc 67:2560–2567, 2019.
KW - cardiovascular disease risk
KW - low-density lipoprotein cholesterol
KW - older adults
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U2 - 10.1111/jgs.16123
DO - 10.1111/jgs.16123
M3 - Article
C2 - 31411740
AN - SCOPUS:85071149632
SN - 0002-8614
VL - 67
SP - 2560
EP - 2567
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 12
ER -