TY - JOUR

T1 - Altered cardiovascular risk pattern of LDL cholesterol in older adults

AU - Rozing, Maarten Pieter

AU - Westendorp, Rudi G.J.

N1 - Publisher Copyright: Copyright 2022 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2023

Y1 - 2023

N2 - Purpose of reviewElevated serum low-density lipoprotein cholesterol (LDL-C) levels at middle-age constitute a strong risk factor for later cardiovascular events. In older populations, however, LDL-C levels are no longer predictive of cardiovascular mortality or may even seem protective. Whether the altered risk pattern of LDL-C in old age reflects a causal mechanism or is due to confounding and bias is subject to debate. In this review, we briefly discuss the possible explanations for the altered risk pattern of LDL-C observed in old age.Recent findingsUsing examples from the recent literature we illustrate how LDL-C levels 'lose' their predictive value as a cardiovascular risk factor in old age. We review three potential explanations for the changed cardiovascular risk pattern of LDL-C in older populations: survivorship bias, reverse causation, and effect modification.SummaryThe absent or protective effect of LDL-C on cardiovascular mortality in older populations found in observational studies might be explained by survivorship bias, reverse causation, and effect modification. However, this does not necessarily preclude the possibility that (specific) cholesterol-lowering treatment could decrease the risk of morbidity and mortality. Placebo-controlled trials may importantly add to our understanding of who may benefit from lipid-lowering therapy or statins at an older age. copy;

AB - Purpose of reviewElevated serum low-density lipoprotein cholesterol (LDL-C) levels at middle-age constitute a strong risk factor for later cardiovascular events. In older populations, however, LDL-C levels are no longer predictive of cardiovascular mortality or may even seem protective. Whether the altered risk pattern of LDL-C in old age reflects a causal mechanism or is due to confounding and bias is subject to debate. In this review, we briefly discuss the possible explanations for the altered risk pattern of LDL-C observed in old age.Recent findingsUsing examples from the recent literature we illustrate how LDL-C levels 'lose' their predictive value as a cardiovascular risk factor in old age. We review three potential explanations for the changed cardiovascular risk pattern of LDL-C in older populations: survivorship bias, reverse causation, and effect modification.SummaryThe absent or protective effect of LDL-C on cardiovascular mortality in older populations found in observational studies might be explained by survivorship bias, reverse causation, and effect modification. However, this does not necessarily preclude the possibility that (specific) cholesterol-lowering treatment could decrease the risk of morbidity and mortality. Placebo-controlled trials may importantly add to our understanding of who may benefit from lipid-lowering therapy or statins at an older age. copy;

KW - cardiovascular

KW - cholesterol

KW - lipid-lowering therapy

U2 - 10.1097/MOL.0000000000000859

DO - 10.1097/MOL.0000000000000859

M3 - Review

C2 - 36413436

AN - SCOPUS:85146364236

VL - 34

SP - 22

EP - 26

JO - Current Opinion in Lipidology

JF - Current Opinion in Lipidology

SN - 0957-9672

IS - 1

ER -