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Serum lipid profiles and their relationship to cardiovascular disease in the elderly: the PREV-ICTUS study

ABSTRACT Objective: To assess the relationship between different serum lipid profiles and the prevalence of established cardiovascular disease (CVD) in an elderly population. Research design and methods: An analysis was undertaken of the PREV-ICTUS population-based study on Spanish subjects aged ≥ 60 years. The following definitions were used: abnormal LDL cholesterol (LDL-C): ≥ 130 mg/dl (≥ 3.3 mmol/L), or ≥ 100 mg/dl (≥ 2.5 mmol/L) in those with diabetes or CVD, or treatment with any hypolipidaemic drug; low HDL cholesterol (HDL-C): < 40 mg/dl (< 1 mmol/L) (men), or < 50 mg/dl (< 1.3 mmol/L) (women), and abnormal triglycerides (TG): ≥ 150 mg/dl (≥ 1.7 mmol/L) or treatment with fibrates. We defined eight groups: A (normal lipid profile), B (isolated abnormal LDL-C), C (isolated abnormal TG), D (isolated low HDL-C), E (abnormal LDL-C and HDL-C), F (abnormal LDL-C and TG), G (abnormal TG and HDL-C), H (abnormal LDL-C, HDL-C and TG). A multivariate analysis was performed to assess the relationship between each lipid profile and CVD. Results: A total of 6010 subjects (mean age 71.7 years, 53.5% women, 73.2% with hypertension, 29.2% with diabetes mellitus, 24.3% with CVD), were included in the analysis. LDL-C elevation was present in 78.1%, 23.3% had low HDL-C and 35.7% abnormal TG. Combined dyslipidaemias were frequent (40.3%). Odds ratios (95% confidence intervals) for CVD, compared with those with a normal lipid profile, were 2.07 (1.24–3.46) for abnormal HDL-C ( p = 0.005), 4.09 (3.10–5.39) for abnormal LDL-C; 6.41 (4.59–8.95) for abnormal LDL-C plus HDL-C, 5.33 (3.98–7.14) for abnormal LDL-C plus TG and 7.59 (5.51–10.5) for those with the three parameters altered (all p < 0.001). Compared with those with isolated LDL-C elevation, those with abnormal LDL-C plus HDL-C had 1.57 (1.30–1.97) higher odds of having CVD ( p < 0.001), the figures being 1.30 (1.11–1.53) for those with abnormal LDL-C plus TG and 1.86 (1.52–2.28) for those with abnormal LDL-C, TG plus HDL-C ( p < 0.001). Conclusions: Lipid abnormalities are frequent in the elderly, and are associated with the presence of CVD. Low HDL-C and/or abnormal TG levels, when added to abnormal LDL-C, are associated with a higher prevalence of CVD, suggesting the advisability of a comprehensive lipid evaluation and treatment earlier in life.