DETERMINANTS OF CHANGE IN TOTAL CHOLESTEROL AND HDL-C WITH AGE - THE FRAMINGHAM-STUDY

Objective: The purpose of the study was to assess the determinants of change of total cholesterol and high density lipoprotein cholesterol ( HDL-C) change in an adult population. Methods. The prospective cohort was examined at baseline and eight. years later. A total of 2,222 men and 2,677 women age 20-79 years at baseline were included. Analyses we re performed in 15-year age groups, and persons with cardiovascular di sease or cancer during the observation period were excluded. Results. In longitudinal analyses, body mass index (BMI) and plasma total chole sterol levels of each rose in concert among younger age groups, wherea s levels declined in older individuals. Mean levels of BMI and total c holesterol peaked at a later age in women than in men. The correspondi ng changes in HDL-C were negative at all ages, and greater declines we re seen in the elderly. A decrease in plasma total cholesterol was hig hly associated with greater age and a decrease in body mass index over the study interval, whereas the decline in HDL-C was proportional to change in body mass index. These changes remained significant after ad justment for baseline age and change in alcohol intake, cigarette cons umption, diuretic use, and oral estrogen use. Conclusions. The rise in plasma total cholesterol among apparently healthy young men and women and its fall in the elderly are significantly associated with similar trends for obesity. The key determinants of a decline in HDL-C are an increase in obesity and advancing age itself. A decline in total chol esterol and in HDL-C is particularly common among the elderly, and it can be expected to occur without specific dietary or pharmacologic int ervention.