EFFECT OF SERUM-LIPIDS, LIPOPROTEINS, AND APOLIPOPROTEINS ON VASCULARAND NONVASCULAR MORTALITY IN THE ELDERLY

The purpose of this study was to determine the effect of serum lipids, lipoprotein fractions, and apolipoprotein (ape) A-1, B, and E on mort ality from vascular and nonvascular causes in an unselected elderly po pulation. The random sample of 347 community-living individuals aged 6 5 years or older was obtained in 1982. Serum total cholesterol, LDL ch olesterol (LDL-C), HDL cholesterol (HDL-C), triglyceride, and apo A-1, B, and E were determined at baseline. After the Ii-year follow-up, 19 9 of the participants had died, and 148 were still alive. Mortality da ta from vascular and nonvascular causes by the end of 1993 were obtain ed from official registers. In the univariate analysis, a low total ch olesterol level was associated with death due to both vascular and non vascular causes (P value for trend, .021 and .0027, respectively). Aft er the adjustment for other risk factors, the inverse association betw een total cholesterol and vascular mortality disappeared, but low tota l cholesterol was still a significant predictor of death due to nonvas cular causes. Adjusted relative risks (RRs) of death due to nonvascula r causes for those with elevated total cholesterol (5.1 to 6.5, 6.6 to 8.0, and >8.0 mmol/L) compared with the reference group (less than or equal to 5.0 mmol/L) were 0.5 (95% confidence interval [CI], 0.2 to 1 .2), 0.6 (0.2 to 1.0), and 0.2 (0 to 0.8), respectively. Neither conce ntrations of HDL-C, LDL-C, triglyceride, nor apo B were associated wit h vascular or nonvascular mortality. On the other hand, low concentrat ion of apo A-1 predicted vascular death. The RR for the lowest tertile was 1.6 (1.1 to 2.5)compared with the highest tertile. Furthermore, t he occurrence of the apa E e4 allele was associated with increased ris k of vascular mortality (RR, 1.5; 95% CI, 1.0 to 2.2), but the risk wa s not related to the levels of lipids, lipoproteins, or other apolipop roteins at baseline. Nonvascular mortality also tended to be predicted by the presence of the e4 allele (RR, 1.5; 95% CI, 0.9 to 2.5). In an unselected elderly population, the allelic variation of apo E, ie, th e presence of the e4 allele, and a low concentration of apo A-1 were m ore accurate indicators of vascular mortality than total cholesterol o r lipoprotein fractions. The risk associated with the apo E polymorphi sm is unrelated to dyslipidemia.