Low-density lipoprotein cholesterol in oldest old with acute myocardial infarction: Is lower the better?,Age and Ageing

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Low-density lipoprotein cholesterol in oldest old with acute myocardial infarction: Is lower the better?
Age and Ageing ( IF 6.7 ) Pub Date : 2022-09-02 , DOI: 10.1093/ageing/afac202
Hui-Hui Liu ₁ , Meng Zhang ₁ , Run-Zhen Chen ₁ , Jin-Ying Zhou ₁ , Jie Qian ₁ , Ke-Fei Dou ₁ , Hong-Bing Yan ₂ , Jian-Jun Li ₁

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BACKGROUND the relationship between low-density lipoprotein cholesterol (LDL-C) and adverse outcomes among the older people remains controversial. OBJECTIVE 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). DESIGN a prospective cohort study. SETTING two-centre. SUBJECTS a consecutive sample of 1,224 oldest old individuals with AMI admitted to Beijing FuWai and Shenzhen FuWai hospitals. METHODS 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. RESULTS 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. CONCLUSIONS 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.

更新日期：2022-09-02

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