Low levels of high-density lipoprotein cholesterol are a marker of disability in the elderly

Background: in the elderly, high-density lipoprotein cholesterol (HDL-C) se ems to have further clinical meanings besides the inverse relationship with coronary heart disease (CHD); indeed, low values have been found in elderl y subjects with functional disability, chronic illness, and in severe clini cal conditions. Objective: To verify the hypothesis that low HDL-C might be a 'marker' for disability, we evaluated the relationship between lipoprote in parameters and functional status, over a period of 2 years, in a large s ample of institutionalized elderly. Methods: 344 institutionalized subjects aged over 65 years were studied. They were divided into two groups accordi ng to basal disability level: 'low-mild': class A-E, and 'high': class F-G of the Katz index. 124 survivors, independent in at least two basic activit ies of daily living (BADL) at enrollment, were divided into two groups on t he basis of 2 years' modifications in functional status: stable/improved or worsened (lost greater than or equal to 2 BADL). Results: Total cholestero l, LDL-C, HDL-C, and apo A-I levels were lower in the high disability group , while no differences in triglycerides and apo B levels emerged. Multiple logistic regression analysis showed that severe disability was associated w ith HDL-C (II vs. III tertile: OR 2.01; CI 95% 1.04-3.91; I vs. III tertile : OR 2.52; CI 95% 1.23-5.15), total cholesterol (I vs. III tertile: OR 2.35 ; CI 95% 1.14-4.81), blood glucose (OR 0.98), and body mass index (OR 0.91) , independently from uric acid, number of pathologies, number of drugs, bod y cell mass, vitamin B-12 and folic acid plasma levels, waist/hip ratio, ag e, and gender. Subjects who lost greater than or equal to 2 BADL in the 2-y ear follow-up consistently showed lower basal HDL-C levels compared to subj ects with stable/improved functional status, and this difference was signif icant after adjustment for basal Katz class, age, gender, number of patholo gies, brood glucose, body mass index, and waist/hip ratio. Conclusions: The results of this study suggest that in the elderly severe disability is str ongly associated with low HDL-C levels. Longitudinal data support the hypot hesis that low HDL-C might be considered as a marker for 'ongoing' disabili ty in BADL. Copyright (C) 1999 S. Karger AG, Basel.