Institute of Aging Research, Hadassah-Hebrew University Medical Center, and Hebrew University-Hadassah Medical School, Mount Scopus, Jerusalem, Israel; Department of Geriatrics and Rehabilitation, Hadassah-Hebrew University Medical Center, and Hebrew University-Hadassah Medical School, Mount Scopus, Jerusalem, Israel.
J Am Med Dir Assoc. 2013 Dec;14(12):883-8. doi: 10.1016/j.jamda.2013.08.012. Epub 2013 Oct 3.
The importance of cholesterol as a risk factor among older people, particularly among the very old, is controversial. Whether or not hypercholesterolemia warrants medical concern, and whether statins are beneficial among very old people, remain unresolved common clinical dilemmas. This study examines whether increased total cholesterol (TC) was associated with higher mortality from age 70 to 90, and if statins had a protective effect.
A representative sample (born 1920-1921) from the Jerusalem Longitudinal Cohort Study (1990-2010) was assessed at ages 70, 78, and 85 for fasting serum TC, low-density (LDL), and high-density lipoprotein (LDL); triglycerides; statin usage; social, functional, and medical domains; and all-cause mortality data (1990-2010). TC was analyzed as either continuous (10 mg/dL increments) or dichotomous variable (high TC >200 mg/dL). Cox proportional hazards models determined mortality hazard ratios (HRs), adjusting for TC, statin treatment, gender, self-rated health, smoking, hypertension, diabetes, ischemic heart disease, neoplasm, body mass index, albumin, and triglycerides.
Prevalence of high TC at ages 70, 78, and 85 was 75% (n = 344), 65% (n = 332), and 34% (n = 237), and statin use was 0%, 17.9%, and 45.4%, respectively. Survival was increased (not significantly) among subjects with high TC >200 mg/dL versus ≤200 mg/dL from ages 70 to 78, 78 to 85, and 85 to 90: 79.1% versus 73.3% (log rank P = .16), 68.7% versus 61.5% (P = .10), and 73.4% versus 70.3% (P = .45), respectively. Survival was significantly increased among subjects treated with statins versus no statins at ages 78 to 85 (74.7% vs 64.3%, log rank P = .07) and 85 to 90 (76.2% vs 67.4%, P = .01). After adjustment, TC (continuous or dichotomous) was not associated with mortality from 70 to 78, 78 to 85, or 85 to 90. In contrast, statins at age 85 were associated with decreased mortality from age 85 to 90 (adjusted HR 0.61, 95% confidence interval 0.42-0.89).
Among older people, cholesterol levels were unrelated to mortality between the ages of 70 and 90. The protective effect of statins observed among the very old appears to be independent of TC.
胆固醇作为老年人（尤其是非常老年人）的一个风险因素的重要性存在争议。高胆固醇是否需要医学关注，以及他汀类药物是否对非常老年人有益，这些仍然是未解决的常见临床难题。本研究旨在探讨从 70 岁到 90 岁时总胆固醇（TC）升高是否与死亡率升高有关，以及他汀类药物是否具有保护作用。
从耶路撒冷纵向队列研究（1990-2010 年）中选取一个代表性样本（1920-1921 年出生），在 70 岁、78 岁和 85 岁时检测空腹血清 TC、低密度脂蛋白（LDL）和高密度脂蛋白（HDL）、甘油三酯、他汀类药物使用情况、社会、功能和医疗领域以及 1990-2010 年的全因死亡率数据。TC 分析采用连续（每 10mg/dL 增加）或二分变量（高 TC >200mg/dL）。Cox 比例风险模型确定死亡率风险比（HR），调整 TC、他汀类药物治疗、性别、自我评估健康状况、吸烟、高血压、糖尿病、缺血性心脏病、肿瘤、体重指数、白蛋白和甘油三酯。
70 岁、78 岁和 85 岁时高 TC 的患病率分别为 75%（n=344）、65%（n=332）和 34%（n=237），他汀类药物使用率分别为 0%、17.9%和 45.4%。从 70 岁到 78 岁、78 岁到 85 岁和 85 岁到 90 岁，高 TC >200mg/dL 组的生存率（log 秩 P=0.16）、79.1%与 73.3%、68.7%与 61.5%和 73.4%与 70.3%，均呈非显著增加。与未使用他汀类药物的患者相比，使用他汀类药物的患者在 78-85 岁（74.7%比 64.3%，log 秩 P=0.07）和 85-90 岁（76.2%比 67.4%，P=0.01）的生存率显著提高。经调整后，TC（连续或二分变量）与 70-78、78-85 或 85-90 岁之间的死亡率无相关性。相比之下，85 岁时使用他汀类药物与 85-90 岁之间的死亡率降低有关（调整后的 HR 0.61，95%置信区间 0.42-0.89）。
在老年人中，胆固醇水平与 70 岁至 90 岁之间的死亡率无关。在非常老年人中观察到的他汀类药物的保护作用似乎与 TC 无关。
