FOR RELEASE: 2 p.m. CT, FridayMarch 2, 2001
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Abstract P62
American Heart Association meeting report: Study raises questions about when and how far to lower blood cholesterol in elderly men
SAN ANTONIO, March 2 -- Less may not be best with cholesterol - at least in elderly men.
A long-term study has found that men older than age 70 with total cholesterol readings between 200 to 219 milligrams per deciliter (mg/dL) are less likely to develop coronary heart disease than those with higher or lower levels of cholesterol. The findings are reported today at the American Heart Association's 41st Annual Conference on Cardiovascular Disease Epidemiology and Prevention.
"People have the impression that the lower the cholesterol, the better," says lead author Beatriz L. Rodriguez, M.D., Ph.D., a professor of medicine at the University of Hawaii in Honolulu.
"The study indicates that in the elderly, it is not good to have cholesterol too high, and it is not good to have it too low. A cholesterol level of 200 mg/dL to 219 mg/dL appears to be the optimal level for people in this age group," she says.
Elevated cholesterol significantly raises the risk of heart attack in young and middle-aged individuals, and the higher the cholesterol, the higher the risk. However, the same relationship has not been found consistently in the few studies that have looked at cholesterol levels and heart risk in people over age 70, says Rodriguez.
The American Heart Association says that total cholesterol levels of 240 mg/dL or higher are considered high, and levels from 200 to 239 mg/dL are considered borderline-high. The association recommends reducing cholesterol levels to below 200 mg/dL through diet, exercise and medication, if needed.
"Lowering high cholesterol in the young and middle-aged makes sense, based on scientific studies," adds co-author J. David Curb, M.D., professor of medicine at the University of Hawaii and principal investigator for the Honolulu Heart Program. "However, I'm not sure that is the case with the elderly, and this research makes the argument that we ought to be careful about making that assumption."
"As a physician, I would be a little more cautious about treating or continuing to treat elderly people whose cholesterol is below 200," says Curb.
The researchers studied a group of men participating in the ongoing Honolulu Heart Project that began in 1965 and included 8,000 Japanese-American men living in Honolulu and elsewhere on the island of Oahu.
Between 1991 and 1993, researchers examined and enrolled 2,424 men from the project, ages 71 to 93, into the cholesterol study and tracked them for up to six years. They excluded men who had been diagnosed with coronary heart disease, had suffered a stroke, or who were taking cholesterol-lowering drugs.
Participants were divided into six groups: those with cholesterol levels less than 160 mg/dL; and those with readings of 160-179, 180-199, 200-219, 220-239, and 240 mg/dL and above. They were followed until 1996, and 145 new cases of coronary heart disease developed during this period. Men in this age group with intermediate cholesterol levels - between 200 and 219 mg/dL - had the lowest rate of coronary heart disease.
When the team analyzed the data, they discovered that the men with cholesterol readings of 240 mg/dL and higher had a 90 percent greater risk of developing heart disease than those with readings of 200 to 219 mg/dL, something that one could reasonably have expected. More surprising, men with cholesterol readings below 160 mg/dL had a 55 percent greater risk of heart disease than men with readings between 200 and 219 mg/dL.
"Among the elderly, it appears that people with high cholesterol should be treated," Rodriguez says. "However, this study questions how aggressive physicians should be in attempting to lower cholesterol below 200 in this age group. It may not be healthy to drive cholesterol far below this level, and it is important that more clinical trials that include elderly people are conducted to clarify this issue."
These findings remained statistically significant after the researchers adjusted for other heart disease risk factors - smoking, high-blood pressure, diabetes and low levels of so-called "good" high-density lipoprotein (HDL) cholesterol.
The team also considered weight loss of 10 percent or more during the past 20 years. Body weight is a measure of frailty and a possible sign of deteriorating health. Factoring in weight loss slightly reduced the heart risks for men at the high and low ends of the cholesterol reading.
Curb says it is unlikely that the new cholesterol findings are unique to Japanese-American men, although the researchers could not absolutely rule out the possibility.
"We have more than 300 publications and 35 years of experience," he says of the Honolulu Heart Program. "We really haven't found many differences between the risk factors for Japanese and other ethnic groups."Co-authors are Robert D. Abbott, Ph.D.; Kamal H. Masaki, M.D.; Irwin J. Schatz, M.D.; Randi Chen, M.A.; and Katsuhiko Yano, M.D.
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NR01-1257 (Epi/Rodriguez)Media Advisory: Dr. Rodriguez or Dr. Curb can be reached by phone at 808-524-3595. Dr. Rodriguez can be reached by e-mail at [email protected]. Dr. Curb's e-mail address is [email protected]. (Please do not publish contact information.)
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