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In this study of 91,131 individuals aged 20 to 100 years from the Copenhagen General Population Study, the authors sought to investigate the hypothesis that elevated LDL cholesterol is associated with increased risk of myocardial infarction and atherosclerotic cardiovascular disease in patients aged 70 years and older. Over an average follow-up of 7.7 years, there were 1515 incident myocardial infarctions, and 3389 individuals had atherosclerotic cardiovascular disease. The risk of myocardial infarction per 1.0-mmol/L LDL cholesterol increase was increased significantly for the overall population and was amplified for patients aged 70 to 100 years. Similar results were observed for risk of atherosclerotic cardiovascular disease. Risk of myocardial infarction was increased with a 5.0-mmol/L increase in LDL cholesterol versus an increase of 3 mmol/L or less in individuals aged 80 to 100 or 70 to 79 years. The number needed to treat in 5 years to prevent 1 myocardial infarction or atherosclerotic disease event was lowest for individuals aged 70 to 100 years, with a larger number needed to treat with younger age.
These findings demonstrate the highest absolute risk of myocardial infarction and atherosclerotic cardiovascular disease and the lowest number needed to treat to prevent 1 event among people aged 70 to 100 years with elevated cholesterol.
This abstract is available on the publisher's site.
Findings of historical studies suggest that elevated LDL cholesterol is not associated with increased risk of myocardial infarction and atherosclerotic cardiovascular disease in patients older than 70 years. We aimed to test this hypothesis in a contemporary population of individuals aged 70-100 years.
We included in our analysis individuals (aged 20-100 years) from the Copenhagen General Population Study (CGPS) who did not have atherosclerotic cardiovascular disease or diabetes at baseline and who were not taking statins. Standard hospital assays were used to measure LDL cholesterol. We calculated hazard ratios (HRs) and absolute event rates for myocardial infarction and atherosclerotic cardiovascular disease, and we estimated the number needed to treat (NNT) in 5 years to prevent one event.
Between Nov 25, 2003, and Feb 17, 2015, 91 131 individuals were enrolled in CGPS. During mean 7·7 (SD 3·2) years of follow-up (to Dec 7, 2018), 1515 individuals had a first myocardial infarction and 3389 had atherosclerotic cardiovascular disease. Risk of myocardial infarction per 1·0 mmol/L increase in LDL cholesterol was augmented for the overall population (HR 1·34, 95% CI 1·27-1·41) and was amplified for all age groups, particularly those aged 70-100 years. Risk of atherosclerotic cardiovascular disease was also raised per 1·0 mmol/L increase in LDL cholesterol overall (HR 1·16, 95% CI 1·12-1·21) and in all age groups, particularly those aged 70-100 years. Risk of myocardial infarction was also increased with a 5·0 mmol/L or higher LDL cholesterol (ie, possible familial hypercholesterolaemia) versus less than 3·0 mmol/L in individuals aged 80-100 years (HR 2·99, 95% CI 1·71-5·23) and in those aged 70-79 years (1·82, 1·20-2·77). Myocardial infarction and atherosclerotic cardiovascular disease events per 1000 person-years for every 1·0 mmol/L increase in LDL cholesterol were highest in individuals aged 70-100 years, with number of events lower with younger age. The NNT in 5 years to prevent one myocardial infarction or atherosclerotic cardiovascular disease event if all people were given a moderate-intensity statin was lowest for individuals aged 70-100 years, with the NNT increasing with younger age.
In a contemporary primary prevention cohort, people aged 70-100 years with elevated LDL cholesterol had the highest absolute risk of myocardial infarction and atherosclerotic cardiovascular disease and the lowest estimated NNT in 5 years to prevent one event. Our data are important for preventive strategies aimed at reducing the burden of myocardial infarction and atherosclerotic cardiovascular disease in the growing population aged 70-100 years.