Association between lipoprotein cholesterol and future cardiovascular disease and mortality in older adults: a Korean nationwide longitudinal study

Abstract Background Dyslipidemia is considered as an independent health risk factor of cardiovascular disease (CVD), a leading cause of mortality in older adults. Despite its importance, however, there have been few reports on the association between lipoprotein cholesterol and future CVD and cardiovascular (CV) mortality among elderly Asians. This study investigated the association between lipoprotein cholesterol and future CVD and CV mortality in an elderly Korean population using a large nationwide sample. Methods From the cohort database of the Korean National Health Insurance Service, a total of 62,604 adults aged 65 years or more (32,584 men and 30,020 women) were included. High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) values were categorized by quartiles. Cox proportional hazard models and linear regression analyses were used to assess the association between the quartiles of lipoprotein cholesterol and CV events or CV mortality. Results The mean follow-up period was 3.3 years. The incidence rates of ischemic heart disease and ischemic brain disease were 0.97 and 0.61 per 1,000 person-years, and the mortality rates from these diseases were 0.22 and 0.34 per 1,000 person-years. In a completely adjusted model, high HDL-C and LDL-C levels were not associated with the total CV events and deaths from CVD. However, high LDL-C levels were significantly associated with a lower incidence of ischemic brain disease. Furthermore, diabetic patients with high LDL-C were more likely to have higher CV mortality, whereas non-smokers with high LDL-C were less likely to be at risk of CV events. Conclusions Neither high LDL-C nor HDL-C was significantly associated with future CV mortality in older adults aged ≥ 65 years. High LDL-C seems not a risk factor for CVD in the elderly, and further studies are needed.