LACK OF ASSOCIATION BETWEEN CHOLESTEROL AND CORONARY HEART-DISEASE MORTALITY AND MORBIDITY AND ALL-CAUSE MORTALITY IN PERSONS OLDER THAN 70YEARS

Objectives.-To determine whether elevated serum cholesterol level is a ssociated with all-cause mortality, mortality from coronary heart dise ase, or hospitalization for acute myocardial infarction and unstable a ngina in persons older than 70 years. Also, to evaluate the associatio n between low levels of high-density lipoprotein cholesterol (HDL-C) a nd elevated ratio of serum cholesterol to HDL-C with these outcomes. D esign.-Prospective, community-based cohort study with yearly interview s. Participants.-A total of 997 subjects who were interviewed in 1988 as part of the New Haven, Conn, cohort of the Established Population f or the Epidemiologic Study of the Elderly (EPESE) and consented to hav e blood drawn. Main Outcome Measures.-The risk factor-adjusted odds ra tios of the 4-year incidence of all-cause mortality, mortality from co ronary heart disease, and hospitalization for myocardial infarction or unstable angina were calculated for the following: subjects with tota l serum cholesterol levels greater than or equal to 6.20 mmol/L (great er than or equal to 240 mg/dL) compared with subjects with cholesterol levels less than 5.20 mmol/L (<200 mg/dL); subjects in the lowest ter tile of HDL-C level compared with those in the highest tertile; and su bjects in the highest tertile of the ratio of total serum cholesterol to HDL-C level compared with those in the lowest tertile. Results.-Ele vated total serum cholesterol level, low HDL-C, and high total serum c holesterol to HDL-C ratio were not associated with a significantly hig her rate of all-cause mortality, coronary heart disease mortality, or hospitalization for myocardial infarction or unstable angina after adj ustment for cardiovascular risk factors. The risk factor-adjusted odds ratio for all-cause mortality was 0.99 (95% confidence interval [Cl], 0.56 to 2.69) for the group who had cholesterol levels greater than o r equal to 6.20 mmol/L (greater than or equal to 240 mg/dl) compared w ith the group that had levels less than 5.20 mmol/L (<200 mg/dL); 1.00 (95% Cl, 0.59 to 1.70) for the group in the lowest tertile of HDL-C c ompared with those in the highest tertile; and 1.03 (95% Cl, 0.62 to 1 .71) for subjects in the highest tertile of the ratio of total serum c holesterol to HDL-C compared with those in the lowest tertile. Conclus ions.-Our findings do not support the hypothesis that hypercholesterol emia or low HDL-C are important risk factors for all-cause mortality, coronary heart disease mortality, or hospitalization for myocardial in farction or unstable angina in this cohort of persons older than 70 ye ars.