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[QUOTE]NEW YORK (Reuters Health) - LDL cholesterol is known as the "bad" cholesterol, because high levels are linked to heart disease, but low levels may not be good for the elderly.
A new study of older men and women shows that higher LDL cholesterol levels are associated with decreasing mortality risk in women. For both men and women, the risk of fatal heart failure decreases with higher LDL cholesterol levels.

The findings "add to the uncertainty of the role of elevated levels of LDL cholesterol as a risk factor for mortality in old people," according to the researchers who conducted the study.

Dr. Valerie Tikhonoff of the University of Padua, Italy, and colleagues conducted a population-based study of 3120 subjects age 65 years or older, who were followed for up to 12 years.

Tikhonoff''s group reports in the Journal of the American Geriatric Society that the likelihood of dying during the follow-up period "was curvilinear ... decreasing nonlinearly with LDL cholesterol."

[B]The total mortality risk in relation to LDL level was J-shaped in men, meaning that the risk increased as LDL cholesterol levels fell below a mid range -- although the risk increased with high levels of LDL. [/B]
Similarly, [B]there was a J-shaped relationship to the risk of dying from cardiovascular causes for both sexes, and for the risk of having a fatal heart attack among men.[/B]

"The key finding of this study was that, in older subjects with a low use of lipid-lowering drugs representative of the general Italian population, serum LDL cholesterol behaved as a multifaceted and predominantly nonlinear predictor of cardiovascular and all-cause mortality," Tikhonoff and colleagues conclude.

They add that results of lipid-lowering drug trials should be interpreted with caution in unselected elderly patients, because these findings contradict the usual association of high LDL cholesterol with mortality risk seen in younger patients.[/QUOTE]

Intriguing article liverock.
Unfortunately, that's all we can get without paying $48.99 for the article. Alas.
A couple thoughts, since we are dealing here with a sample of people who are dying largely in their 70's the skewing effects of cancer cannot be ruled out. Low cholesterol levels are a familaiar accompaniment to the cachexia of cancer and occurs even much earlier in the cancer process.
IF the 3,120 people were followed for "up to 12 years" it would be nice to know how many died and what they died of. I would also LOVE to know what the bottom of that J-curve for LDL was for men at which point deaths started increasing with LDL.
For women they are saying a J-shaped relationship (high LDL continues to kill) with regards to heart disease...but NOT for all-mortality. THat indicates to me the point where cancer deaths are showing up in the lower LDL women as expected.
A final point is that of all populations, Italians stand the greatest chance of having the Milano gene that protects against the effect of high LDL; those with the gene have almost no chance of developing heart disease, no matter what.
Can we assume that none of the people were treated with cholesterol lowering drugs????
And damn, WHAT was the J-point LDL level reading! D:D:D! My curiosity is going to kill me. I think the NYPL probably has the journal, maybe eventually I'll get the number.

Here's the ABSTRACT from the journal:
[QUOTE]
Objectives:

To investigate the role of low-density lipoprotein cholesterol (LDL-C) as a predictor of mortality in elderly subjects. Design:

Population-based prospective cohort study. Setting:

Two communities in northern Italy. Participants:

Three thousand one hundred twenty Caucasian subjects aged 65 and older recruited in for the Cardiovascular Study in the Elderly and followed up for 12 years. Measurements:

Anthropometric measures: fasting plasma total cholesterol, triglyceride, high-density lipoprotein cholesterol, LDL-C, glucose, creatinine, and body mass index. Clinical measures: medical assessment, diabetes mellitus, hypertension, stroke, coronary disease, heart failure, and smoking and drinking habits. Vital status measures: death certificates from the Registry Office and causes of death according to the International Classification of Diseases. After plotting mortality rates using quartiles of LDL-C, relative hazard rates (RHRs) were calculated using multivariate Cox regression analyses. When the trend was nonlinear, the RHRs were further calculated for the 25th, 50th, and 75th percentiles of the distribution to confirm curvilinearity. Results:

The distribution of risk of total mortality in women and of fatal heart failure in all subjects was curvilinear (non J-shaped), decreasing nonlinearly with LDL-C. For total mortality in men and cardiovascular mortality in both sexes, the relationship with LDL-C was J-shaped. The risk of fatal myocardial infarction was J-shaped in men, whereas it increased linearly with higher LDL-C in women. In both sexes, the association between stroke mortality and LDL-C was not significant. Conclusion:

This study adds to the uncertainty of the role of elevated levels of LDL-C as a risk factor for mortality in old people.[/QUOTE]

And then in Medscape:
[QUOTE]Dr. Tikhonoff's group found that "the distribution of risk of total mortality in women and of fatal heart failure in all subjects was curvilinear (non-J-shaped), decreasing nonlinearly with LDL cholesterol."

The risk of total mortality with LDL level was J-shaped in men; the risk of cardiovascular mortality was J-shaped for both sexes; [B]and the risk of fatal MI was J-shaped in men and increased linearly in women.[/B] LDL cholesterol was not a significant factor in stroke mortality in either sex.[/QUOTE]

Am I reading this wrong or does it indeed say that "the risk of fatal MI [B]increased linearly[/B] (presumably with LDL) in women"...and thus means that the common wisdom holds, that increasing LDL causes more fatal heart attacks (in women of any age?)

GOOD:
I located the article in the Mid-Manhattan branch of the NYPL...I'll get in on Friday and Xerox it.





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