Low total cholesterol predicts mortality in the nondemented oldest old

Plasma lipid concentrations and survival in geriatric population: A retrospective cohort study

Plasma lipids in mid-life are important predictors for cardiovascular events and deaths. However, the association between plasma lipid concentrations and mortality in late life is controversial. Recent studies showed that older people with extremely low total cholesterol (TC) have poor survival outcome, but this conclusion was drawn mostly from Western cohorts. Our study investigated association between plasma lipid concentrations and mortality in Taiwanese elderly population.A retrospective cohort study was conducted among the 69,824 elderly people who participated in the Taipei City Geriatric Health Examination between 2006 and 2010, with a mean follow-up of 3.6 years. The measurements of TC, high density lipoprotein (HDL) and triglycerides were obtained from the records of the participants. Low density lipoprotein (LDL) was calculated using Friedewald formula in 69,088 participants. All lipid components were categorized into quartiles. Males and females were analyzed separately using multivariate Cox proportional hazards models.The elderly with the lowest quartile of TC (<175 mg/dL), HDL cholesterol (<43 mg/dL) and LDL cholesterol (<100.4 mg/dL) were at higher risk of all-cause mortality. Older females with the lowest quartile of TC and LDL cholesterol had higher cardiovascular mortality. Older females with the lowest quartile of HDL had higher mortality from cardiovascular and cerebrovascular diseases.We concluded that TC, mostly attributed to LDL cholesterol, was inversely related to all-cause mortality. HDL remained to be protective against both cardiovascular and stroke mortality in older females. The target levels of plasma lipids in people older than 65 years should be different from that in younger adults.

Triglycerides Paradox Among the Oldest Old: "The Lower the Better?"

OBJECTIVES

Currently, most treatment guidelines suggest lowering hypertriglyceridemia of any severity, even in elderly individuals. However associations of serum triglycerides (TGs) with adverse health and mortality risk decrease with age, it remains unclear among the oldest old (aged 80 years and older). The study was to investigate the relationship of serum TG concentrations with cognitive function, activities of daily living (ADLs), frailty, and mortality among the oldest old in a prospective cohort study.

DESIGN

Longitudinal prospective cohort study.

SETTING

Community-based setting in longevity areas in China.

PARTICIPANTS

A total of 930 (mean age = 94.0 years) Chinese oldest old.

MEASUREMENTS

The TG concentrations were measured at baseline survey in 2009. Cognitive function, ADLs, frailty, and mortality were determined over 5 years of follow-up. Cox proportional hazards models and competing risk models were performed to explore the association, adjusting for potential confounders.

RESULTS

Each 1-mmol/L increase in TGs was associated with a nearly 20% lower risk of cognitive decline, ADL decline, and frailty aggravation during the 5 years of follow-up. Consistently, higher TGs (each 1 mmol/L) was associated with lower 5-year all-cause mortality after fully adjustment (hazard ratio [HR] = 0.79; 95% confidence interval [CI] = 0.69-0.89). Nonelevated TG concentrations (less than 2.26 mmol/L) were associated with higher mortality risk (HR = 1.72; 95% CI = 1.22-2.44), relative to TGs of 2.26 mmol/L or more. We observed similar results regarding TG concentrations and mortality in 1-year lag analysis and when excluding participants with identified chronic disease.

CONCLUSION

In the oldest old, a higher concentration of TGs was associated with a lower risk of cognitive decline, ADL decline, frailty aggravation, and mortality. This paradox suggests the clinical importance of revisiting the concept of "the lower the better" for the oldest old. J Am Geriatr Soc 67:741-748, 2019.

A Dedicated Nutritional Care Program (NUTRICARE) to reduce malnutrition in institutionalised dysphagic older people: A quasi-experimental study

AIMS AND OBJECTIVES

To assess the effects of a texture-modified food program for dysphagia on the nutritional, biochemical and functional profile in a cohort of institutionalised older people in Italy.

BACKGROUND

Dysphagic institutionalised older people, often also affected by dementia, are frequently exposed to malnutrition. Malnutrition in older people has negative effects on mortality, days of hospitalisation, infection, wound healing and risk of pressure injuries. Therefore, it is very important to prevent malnutrition in this frail population.

DESIGN

A pre-post study without a control group.

METHODS

The study included 479 dysphagic institutionalised older people from 20 nursing homes. Anthropometrical, biochemical, nutritional and functional parameters were collected retrospectively, 6 months before the study intervention, at time zero and, prospectively for 6 months after implementing the NUTRICARE food programme, for a total of nine evaluations. The NUTRICARE programme includes meals without nutritional supplementation, and personalised levels of density, viscosity, texture and particle size.

RESULTS

The total mean body mass index of our sample passed from 17.88-19.00; body weight averagely improved by 7.19%, as well as their nutritional and biochemical profiles. There was a progressive improvement of total protein and serum albumin values. Nutritional parameters (serum transferrin and lymphocytes) displayed similar changes. Plasma lymphocytes reached normal levels in 98.23% of the sample. Plasma creatinine levels remained steady throughout the study and within the normal range. No side effects were reported.

CONCLUSION

The NUTRICARE food programme with a adequate proteins, calories, balanced nutritional and bromatological properties, and appropriate texture and palatability significantly improved the nutritional, biochemical and functional profile in a cohort of institutionalised dysphagic older people.

RELEVANCE TO CLINICAL PRACTICE

The introduction of a balanced nutritional programme, using high-quality natural ingredients, appropriate texture and palatability can significantly improve health and quality of life in dysphagic older people.

Demographics, phenotypic health characteristics and genetic analysis of centenarians in China

After a brief introduction to the background, significance and unique features of the centenarian population in China, we describe the Chinese Longitudinal Healthy Longevity Study (CLHLS), which is the world's largest study of centenarians, nonagenarians, octogenarians, and compatible young-old aged 65-79. Based on the CLHLS data and other relevant studies, we summarize demographic and socioeconomic characteristics as well as self-reported and objectively-tested health indicators of centenarians in China, with an emphasis on gender differences and rural/urban disparities. We then compare five-year-age-specific trajectories of physical and cognitive functions, self-reported health, and life satisfactions from ages 65-69 to 100+, concluding that good psychological resilience and optimism are keys to the exceptional longevity enjoyed by centenarians. We discuss recent findings of novel loci and pathways that are significantly associated with longevity based on the genome-wide association study (GWAS) of the CLHLS centenarian sample, which is 2.7 times as large as prior GWAS of longevity. We also highlight colleagues' and our own studies on longevity candidate genes and gene-environment interaction analyses. Finally, we discuss limitations inherent in our studies of centenarians in China and further research perspectives.

Hypolipidemic drugs in elderly subjects: Indications and limits

AIMS

Cardiovascular disease is a major cause of death worldwide. Safety and efficacy of lipid lowering therapy have been clearly established for either primary and secondary prevention of cardiovascular events in adults. Nevertheless, the use of hypolipidemic drugs in elderly individuals, especially in the oldest ones, still raises some concerns. Aim of this paper is to review indications and limits of lipid lowering in advanced age, furnishing a practical medical attitude tempered by clinical and geriatric competences.

DATA SYNTHESIS

While figures from randomized controlled trials and from observational studies seem to support the use of lipid lowering drugs for secondary prevention in the elderly, drawing inferences from primary prevention in old populations is far more challenging. Although these pharmacological agents seem to reduce the incidence of cardiovascular events, they do not prolong survival. In addition, there is some doubt about the cost-effectiveness of treatment because of a more delicate balance between benefit and potential adverse reactions. However, lipid-lowering drugs seem largely underutilized in older age, mainly due to safety concerns that must be reconsidered, at least in part, given the somewhat reassuring results deriving from specific cohort surveys.

CONCLUSIONS

Data on the use and on the effects of lipid lowering drugs in elderly populations are incomplete, especially those concerning very old subjects without established cardiovascular disease. Comprehensive guidelines for the management of dyslipidemias in this rapidly-growing population is a urgent need, and treatment should be based, besides the aforementioned considerations, on patient preferences, cognitive function and life expectancy.

The importance of HDL-C and CRP in cardiovascular risk evaluation in longevous elderly individuals

The association between total mortality, lipoproteinS, and inflammatory markers, and their implications with aging and longevity are often controversial. Among the most often studied markers are low HDL cholesterol and high C-reactive protein. Particularly in octogenarians, it is expected that the impact of the inclusion of HDL cholesterol and C-reactive protein will improve the stratification of absolute cardiovascular risk. In the present study, we performed a literature review in PubMed about the relation between HDL cholesterol, inflammation and longevity. Applying the inclusion and exclusion criteria adopted, we selected 30 studies, among which one systematic review on the relation between HDL cholesterol and stroke, one meta-analysis on the relation between total cholesterol and HDL cholesterol with mortality, 22 longitudinal studies, and six cross-sectional studies. The results show an inverse association between HDL cholesterol and total mortality, and between cardiovascular mortality and C-reactive protein, as well as a positive association between C-reactive protein and mortality in longevous individuals. C-reactive protein and HDL cholesterol displayed promising characteristics as predictors of cardiovascular mortality in longevous elderly persons.

Lipids and all-cause mortality among older adults: a 12-year follow-up study

This is a 12-year follow-up cohort study with 800 people (60–85 years old). The association between lipid disorders and mortality was analysed by Cox proportional hazard adjusted model. All-cause mortality was considered the dependent variable, and lipid disorders as independent variables: total cholesterol (TC) >200 and <170 mg/dl, HDL-c <35 and 40, LDL-c >100 and 130, and triglycerides (TG) >50. An initial analysis of all subjects was performed and a second was carried out after having excluded individuals with a body mass index (BMI) <20 kg/m² or mortality in ≤2 years. The mortality showed a positive association with low TC and a negative association with high TC and high LDL-c. After the exclusion of underweight and premature mortality, there was a positive association only with TC <170 mg/dl (HR = 1.36, CI95%: 1.02–1.82). The data did not show a higher risk with high levels of TC, LDL-c, and TG. However, they showed higher mortality among older adults with low TC.

Serum total cholesterol levels and all-cause mortality in a home-dwelling elderly population: a six-year follow-up

OBJECTIVE

To investigate the association between serum total cholesterol and all-cause mortality in elderly individuals aged > or = 75 years. Design. A prospective cohort study with a six-year follow-up.

SETTING AND SUBJECTS

A random sample (n = 700) of all persons aged > or = 75 years living in Kuopio, Finland. After exclusion of participants living in institutional care and participants using lipid-modifying agents or missing data on blood pressure and cholesterol levels, the final study population consisted of 490 home-dwelling elderly persons with clinical examination. We used the Cox proportional hazard model and the propensity score (PS) method. Main outcome measure. All-cause mortality. Results. In an age- and sex-adjusted analysis, participants with S-TC > or = 6mmol/l had the lowest risk of death (hazard ratio, HR = 0.48, 95% CI 0.33-0.70) compared with those with S-TC < 5 mmol/l. HR of death for a 1 mmol increase in S-TC was 0.78. In multivariate analyses, the HR of death for a 1 mmol increase in S-TC was 0.82 and using S-TC < 5 mmol/l as a reference, the HR of death for S-TC > or = 6 mmol/l was 0.59 (95% CI 0.39-0.89) and for S-TC 5.0-5.9 mmol/l, the HR was 0.62 (95% CI 0.42-0.93). In a PS-adjusted model using S-TC < 5 mmol/l as a reference, the HR of death for S-TC > or = 6 mmol/l was 0.42 (95% CI 0.28-0.62) and for S-TC 5.0-5.9 mmol/l, the HR was 0.57 (95% CI 0.38-0.84). Conclusions. Participants with low serum total cholesterol seem to have a lower survival rate than participants with an elevated cholesterol level, irrespective of concomitant diseases or health status.