CROSS-SECTIONAL AND LONGITUDINAL CHANGES IN TOTAL AND HIGH-DENSITY-LIPOPROTEIN CHOLESTEROL LEVELS OVER A 20-YEAR PERIOD IN ELDERLY MEN - THE HONOLULU HEART PROGRAM

PURPOSE: The purpose of this report is to describe levels of total cho lesterol and high-density-lipoprotein cholesterol (HDL-C) in a group o f elderly men and to compare these levels to those that were observed 20 years earlier. METHODS: From 1965-1968, the Honolulu Heart Program began following 8006 men of Japanese ancestry living on the island of Oahu, Hawaii, in a prospective study of coronary heart disease and str oke. This report presents data for 971 men who participated in a separ ate fasting study of lipids and lipoproteins that first occurred from 1970-1972 and in those who received repeat examinations 10 and 20 year s later. Men were aged 71-93 years at the last examination. RESULTS: O ver the 20-year period, total cholesterol declined by 1.6-1.8 mg/dL pe r year (P < 0.001), from average baseline values of 219-222 mg/dL. Lev els of HDL-C rose 0.2-0.3 mg/dL per year (P ( 0.001), from average bas eline Values of 44-46 mg/dL. After adjustment for baseline cholesterol levers, men with prevalent coronary heart disease at the end of the 2 0-year follow-up experienced significantly greater reductions in total cholesterol levels than men without disease (P < 0.001). Men who deve loped coronary heart disease within the first 10 years of follow-up ha d the greatest yearly decline in total cholesterol (1.9 mg/dL), follow ed by men who developed heart disease later (1.8 mg/dL) and men who re mained disease free (1.5 mg/dL). Differences between men with recent a nd earlier disease were not statistically significant, although men wi thout coronary disease experienced a significantly smaller decrease in total cholesterol than either of these groups (P < 0.05). CONCLUSIONS : Changes in total cholesterol and HDL-C levels with advancing age may be part of a natural aging process. Some changes, however, such as la rge reductions in total cholesterol, may signal occult disease or decl ines in overall health. Selective survival may contribute to these fin dings since improvements in lipid and lipoprotein levels that are bene ficial in younger ages were common in this long-lived cohort of men. ( C) 1997 Elsevier Science Inc.