Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 BeiLiShi Road, XiCheng District, Beijing 100037, China.
Department of Coronary Artery Disease, FuWai Hospital Chinese Academy of Medical Sciences, LangShan Road 12, ShenZhen 518000, China.
Age Ageing. 2022 Sep 2;51(9). doi: 10.1093/ageing/afac202.
the relationship between low-density lipoprotein cholesterol (LDL-C) and adverse outcomes among the older people remains controversial.
to further clarify the association between admission LDL-C levels and cardiovascular mortality (CVM) among oldest old individuals (≥80 years) with acute myocardial infarction (AMI).
a prospective cohort study.
two-centre.
a consecutive sample of 1,224 oldest old individuals with AMI admitted to Beijing FuWai and Shenzhen FuWai hospitals.
all individuals were subdivided according to baseline LDL-C levels (<1.8, 1.8-2.6 and ≥ 2.6 mmol/l) and further stratified by high-sensitivity C-reactive protein (hsCRP) concentrations (<10 and ≥10 mg/l). The primary outcome was CVM. The time from admission to the occurrence of CVM or the last follow-up was analysed in Kaplan-Meier and Cox analyses.
the median age of the overall population was 82 years. During an average of 24.5 months' follow-up, 299 cardiovascular deaths occurred. Kaplan-Meier analysis showed that LDL-C < 1.8 mmol/l group had the highest CVM among oldest old individuals with AMI. Multivariate Cox regression analysis further revealed that compared with those with LDL-C levels <1.8 mmol/l, subjects with LDL-C levels ≥2.6 mmol/l (hazard ratio: 0.67, 95% confidence interval: 0.46-0.98) had significantly lower risk of CVM, especially in those with high hsCRP levels. Moreover, when categorising according to LDL-C and hsCRP together, data showed that individuals with low LDL-C and high hsCRP levels had the highest CVM.
LDL-C < 1.8 mmol/l was associated with a high CVM after AMI in oldest old individuals, especially when combined with high hsCRP levels, which may need to be confirmed by randomised controlled trials.
低密度脂蛋白胆固醇（LDL-C）与老年人不良结局之间的关系仍存在争议。
进一步阐明急性心肌梗死（AMI）中最年长人群（≥80 岁）入院时 LDL-C 水平与心血管死亡率（CVM）之间的关系。
前瞻性队列研究。
两中心。
连续入选北京阜外医院和深圳阜外医院的 1224 名最年长的 AMI 患者。
根据基线 LDL-C 水平（<1.8、1.8-2.6 和≥2.6 mmol/L）将所有患者分为亚组，并进一步根据高敏 C 反应蛋白（hsCRP）浓度（<10 和≥10 mg/L）分层。主要终点为 CVM。采用 Kaplan-Meier 法和 Cox 分析比较从入院到 CVM 发生或最后一次随访的时间。
总体人群的中位年龄为 82 岁。平均 24.5 个月随访期间，发生 299 例心血管死亡。Kaplan-Meier 分析显示，AMI 中最年长的患者中，LDL-C<1.8 mmol/L 组的 CVM 最高。多变量 Cox 回归分析进一步表明，与 LDL-C<1.8 mmol/L 的患者相比，LDL-C≥2.6 mmol/L 患者（风险比：0.67，95%置信区间：0.46-0.98）发生 CVM 的风险显著降低，尤其是在 hsCRP 水平较高的患者中。此外，当根据 LDL-C 和 hsCRP 联合分类时，数据显示 LDL-C 水平低和 hsCRP 水平高的患者 CVM 发生率最高。
AMI 后最年长患者 LDL-C<1.8 mmol/L 与 CVM 发生率高相关，尤其是与 hsCRP 水平较高时相关，这可能需要通过随机对照试验来证实。
