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Low 'Good' Cholesterol Predicts Death in Elderly

NEW YORK (Reuters Health) - Low levels of "good" cholesterol, rather than
high levels of "bad" cholesterol, are associated with an increased risk of
death from heart disease and stroke in people who have reached 85 years of
age, according to a report published in the July 14th issue of the Archives
of Internal Medicine.

Although high total cholesterol levels are usually tied to adverse outcomes,
there is evidence that high levels are actually associated with decreased
all-cause mortality in the elderly (see Reuters Health reports October 17,
1997 and August 2, 2001). However, the effect of high-density lipoprotein
(HDL) and low-density lipoprotein (LDL) cholesterol levels on mortality in
this age group is unclear.

Dr. Annelies W. E. Weverling-Rijnsburger, from Leiden University in the
Netherlands, and colleagues measured cholesterol levels in 561 subjects who
had recently reached 85 years of age. The subjects were then followed for 4
years.

During the study period, 152 subjects died and cardiovascular disease was
the leading cause, the investigators note.

Levels of LDL, the "bad" type of cholesterol, did not influence the risk of
death from cardiovascular disease, the authors found. In contrast, low
levels HDL, the "good" cholesterol increased the risk.

Subjects with HDL cholesterol levels below 40 mg/dL were twice as likely to
die from stroke or heart disease than were subjects with levels above 46
mg/dL.

Low levels of HDL as well as LDL cholesterol more than doubled the risk of
death from infection, the investigators state. High total cholesterol levels
were associated with a significantly reduced risk of death from infection.

In addition to indicating that that HDL cholesterol, but not LDL
cholesterol, is a predictor of death in the very old, the results also
suggest that the survival benefits previously seen with high total
cholesterol levels may be due to protection against death from infectious
disease.

Although these laboratory findings are implicated in increased risk, rather
than the direct cause of death, "it may be argued that increasing HDL
cholesterol levels is more advantageous than lowering total cholesterol
levels among old people," the authors conclude.

SOURCE: Archives of Internal Medicine 2003.