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CLINICAL RESEARCH: LIPIDS AND CARDIOVASCULAR DISEASE

Cholesterol and Glucose Metabolism and Recurrent Cardiovascular Events Among the Elderly

A Prospective Study

Timo E. Strandberg, MD, PhD^_*,,_*, Reijo S. Tilvis, MD, PhD, Kaisu H. Pitkala, MD, PhD and Tatu A. Miettinen, MD, PhD

^_* Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland
Oulu University Hospital, Unit of General Practice, Oulu, Finland
Department of Medicine, Clinic of Internal Medicine and Geriatrics, University of Helsinki, Helsinki, Finland

Manuscript received December 30, 2005; revised manuscript received April 13, 2006, accepted April 18, 2006.

^_* Reprint requests and correspondence: Dr. Timo E. Strandberg, Department of Public Health Science and General Practice, University of Oulu, PO Box 5000, FIN-90014, Oulu, Finland. (Email: timo.strandberg{at}oulu.fi).

OBJECTIVES: The aim of this research was to evaluate the prognostic value of cholesterol absorption assessed with the serum cholestanol-to-cholesterol concentration ratio (lower level reflects decreased cholesterol absorption) among elderly cardiovascular patients (DEBATE [Drugs and Evidence-Based Medicine in the Elderly] study).

BACKGROUND: The components of the metabolic syndrome have been unexpectedly associated with better prognosis among elderly cardiovascular patients. On the other hand, a metabolic syndrome-type state is characterized by high synthesis and decreased absorption of cholesterol.

METHODS: This was a prospective cohort study of home-dwelling individuals age 75 years and older with cardiovascular diseases (247 women, 129 men) recruited from the community. Main outcome measure was multivariate-adjusted time to 3.4-year mortality and recurrent major cardiovascular events.

RESULTS: Serum total and low-density lipoprotein cholesterol levels did not predict outcome. Instead, the mortality risk (64 deaths) increased with increasing levels of cholestanol-to-cholesterol ratio. Patients in the 2nd, 3rd, and 4th quartiles had a relative hazard ratio (HR) for death of 2.54 (95% confidence interval [CI] 1.05 to 6.12), 2.48 (95% CI 1.03 to 6.00), and 3.53 (95% CI 1.52 to 8.19) compared with the lowest quartile, even though 50% of individuals in the lowest cholestanol quartile had metabolic syndrome or diabetes. In multivariate models, the lowest cholestanol ratio quartile was independently associated with lower mortality (relative HR, 0.37, 95% CI 0.17 to 0.81), and with fewer major cardiovascular events (115 events, relative HR, 0.59, 95% CI 0.35 to 0.98).

CONCLUSIONS: Low cholesterol absorption was associated with fewer recurrent cardiovascular events, and with better survival in elderly patients despite frequent abnormalities of glucose metabolism.

Abbreviations and Acronyms   APOE = apolipoprotein E   CI = confidence interval   DEBATE = Drugs and Evidence-Based Medicine in the Elderly study   HDL = high-density lipoprotein   HR = hazard ratio   HsCRP = high-sensitivity C-reactive protein   LDL = low-density lipoprotein   MMSE = Mini-Mental State Examination

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