Management of high cholesterol levels in older people

Vascular Ageing: Mechanisms, Risk Factors, and Treatment Strategies

Ageing constitutes the biggest risk factor for poor health and adversely affects the integrity and function of all the cells, tissues, and organs in the human body. Vascular ageing, characterised by vascular stiffness, endothelial dysfunction, increased oxidative stress, chronic low-grade inflammation, and early-stage atherosclerosis, may trigger or exacerbate the development of age-related vascular diseases, which each year contribute to more than 3.8 million deaths in Europe alone and necessitate a better understanding of the mechanisms involved. To this end, a large number of recent preclinical and clinical studies have focused on the exponential accumulation of senescent cells in the vascular system and paid particular attention to the specific roles of senescence-associated secretory phenotype, proteostasis dysfunction, age-mediated modulation of certain microRNA (miRNAs), and the contribution of other major vascular risk factors, notably diabetes, hypertension, or smoking, to vascular ageing in the elderly. The data generated paved the way for the development of various senotherapeutic interventions, ranging from the application of synthetic or natural senolytics and senomorphics to attempt to modify lifestyle, control diet, and restrict calorie intake. However, specific guidelines, considering the severity and characteristics of vascular ageing, need to be established before widespread use of these agents. This review briefly discusses the molecular and cellular mechanisms of vascular ageing and summarises the efficacy of widely studied senotherapeutics in the context of vascular ageing.

Clinical utility of lipid ratios as potential predictors of metabolic syndrome among the elderly population: Birjand Longitudinal Aging Study (BLAS)

BACKGROUND

Elderly adults are at higher risk of developing metabolic syndrome (MetS). The present study aims to investigate the relationship between lipid ratios and MetS in the elderly population.

METHODS

This study was conducted on elderly population of Birjand during 2018-2019. The data of this study was driven from Birjand Longitudinal Aging Study (BLAS). The participants were selected based on multistage stratified cluster sampling. Patients were categorized into quartiles according to the lipid ratios (TG/HDL-C, LDL-C/HDL-C, non-HDL/HDL-C), and the relationship between lipid ratio quartiles and MetS was determined by Logistic Regression using Odds Ratio. Finally, the optimal cut-off for each lipid ratio in MetS diagnosis was calculated according to the Area Under the Curve (AUC).

RESULTS

This study included 1356 individuals, of whom 655 were men and 701 were women. In our study, the crude prevalence of MetS was 792 (58%), including 543 (77.5%) women and 249 (38%) men. Increasing trends were observed in quartiles of all lipid ratios for TC, LDL-C, TG, and DBP. TG/HDL was also the best lipid ratio to diagnose the MetS, based on NCEP ATP III criteria. One unit increased in level of TG/HDL resulted in 3.94 (OR: 3.94; 95%CI: 2.48-6.6) and 11.56 (OR: 11.56; 95%CI: 6.93-19.29) increasing risk of having MetS in quartile 3 and 4 compared to quartile 1, respectively. In men and women, the cutoff for TG/HDL was 3.5 and 3.0, respectively.

CONCLUSIONS

Our results showed that the TG/HDL-C is superior to the LDL-C/HDL-C and the non-HDL /HDL-C to predict MetS among the elderly adults.

Sensorimotor ability and inhibitory control independently predict attainment in mathematics in children and adolescents

We previously linked interceptive timing performance to mathematics attainment in 5- to 11-yr-old children, which we attributed to the neural overlap between spatiotemporal and numerical operations. This explanation implies that the relationship should persist through the teenage years. Here, we replicated this finding in adolescents (n = 200, 11-15 yr). However, an alternative explanation is that sensorimotor proficiency and academic attainment are both consequences of executive function. To assess this competing hypothesis, we developed a measure of a core executive function, inhibitory control, from the kinematic data. We combined our new adolescent data with the original children's data (total n = 568), performing a novel analysis controlling for our marker of executive function. We found that the relationship between mathematics and interceptive timing persisted at all ages. These results suggest a distinct functional link between interceptive timing and mathematics that operates independently of our measure of executive function.NEW & NOTEWORTHY Previous research downplays the role of sensorimotor skills in the development of higher-order cognitive domains such as mathematics: using inadequate sensorimotor measures, differences in "executive function" account for any shared variance. Utilizing a high-resolution, kinematic measure of a sensorimotor skill previously linked to mathematics attainment, we show that inhibitory control alone cannot account for this relationship. The practical implication is that the development of children's sensorimotor skills must be considered in their intellectual development.

Effects of low-density lipoprotein cholesterol on cardiovascular disease and all-cause mortality in elderly patients (≥75 years old)

PURPOSE

Although increased low-density lipoprotein cholesterol (LDL-C) is one of the major risk factors for the cardiovascular disease (CVD), the associations of LDL-C with CVD and all-cause mortality are unclear in elderly (≥75 years) individuals.

METHODS

A total of 3674 individuals aged 75 or older underwent medical examinations at the Kailuan Group from 2006 to 2007, including 3478 males (94.67%) and 196 females (5.33%). Participants were divided into three groups based on the LDL-C level: the ideal level (LDL-C < 100 mg/dl), appropriate level (100 mg/dl ≤ LDL-C < 130 mg/dl) and elevated level (LDL-C ≥ 130 mg/dl) groups. CVD and all-cause mortality events were recorded during the follow-up period. The Cox proportional hazards regression model was applied to evaluate the effects of LDL-C on CVD and all-cause mortality events.

RESULTS

The average follow-up time was 9.87 ± 3.60 years. After adjustment for confounding factors, the multivariate Cox proportional hazards regression model showed that the CVD risk in the elevated level group was 1.45 (95% CI, 1.08-1.95), acute myocardial infarction risk was 1.96 (95% CI, 1.19-3.24) and all-cause mortality risk was 1.18 (95% CI, 1.02-1.37) compared with those in the ideal level group. For every standard deviation increase in LDL-C levels, the CVD risk increased by 10%, acute myocardial infarction risk increased by 21% and all-cause mortality event risk increased by 4%. No association was observed between elevated LDL-C levels and the risk of stroke.

CONCLUSIONS

In the sample of older Chinese individuals investigated in the present study, elevated LDL-C levels (≥130 mg/dl) are a risk factor for CVD and all-cause mortality.

Dihydroartemisinin improves hypercholesterolemia in ovariectomized mice via enhancing vectorial transport of cholesterol and bile acids from blood to bile

The increase of concentrations of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) in the serum of postmenopausal women is the important risk factor of the high morbidity of cardiovascular diseases of old women worldwide. To test the anti-hypercholesterolemia function of dihydroartemisinin (DHA) in postmenopausal women, ovariectomized (OVX) mice were generated, and DHA were administrated to OVX mice for 4 weeks. The blood and liver tissues were collected for biochemical and histological tests respectively. The mRNA and protein expression levels of genes related to metabolism and transport of cholesterol, bile acid and fatty acid in the liver or ileum were checked through qPCR and western blot. DHA could significantly reduce the high concentrations of TC and LDL-C in the serum and the lipid accumulation in the liver of ovariectomized mice. The expression of ABCG5/8 was reduced in liver of OVX mice, and DHA could up-regulate the expression of them. Genes of transport proteins for bile salt transport from blood to bile, including Slc10a1, Slco1b2 and Abcb11, were also significantly up-regulated by DHA. DHA also down-regulated the expression of Slc10a2 in the ileum of OVX mice to reduce the absorption of bile salts. Genes required for fatty acid synthesis and uptake, such as Fasn and CD36, were reduced in the liver of OVX mice, and DHA administration could significantly up-regulate the expression of them. These results demonstrated that DHA could improve hypercholesterolemia in OVX mice through enhancing the vectorial transport of cholesterol and bile acid from blood to bile.

Use of Lipid-Lowering Drugs and Associated Outcomes According to Health State Profiles in Hospitalized Older Patients

Objective

To assess how lipid-lowering drugs (LLDs) are administered in the hospitalized patients aged 65 and older and their association with clinical outcomes according to their health-related profiles.

Design

This is a retrospective study based on data from REPOSI (REgistro POliterapie SIMI - Italian Society of Internal Medicine) register, an Italian network of internal medicine hospital wards.

Setting and Participants

A total of 4642 patients with a mean age of 79 years enrolled between 2010 and 2018.

Methods

Socio-demographic characteristics, functional abilities, cognitive skills, laboratory parameters and comorbidities were used to investigate the health state profiles by using multiple correspondence analysis and clustering. Logistic regression was used to assess whether LLD prescription was associated with patients' health state profiles and with short-term mortality.

Results

Four clusters of patients were identified according to their health state: two of them (Cluster III and IV) were the epitome of frailty conditions with poor short-term outcomes, whereas the others included healthier patients. The average prevalence of LLD use was 27.6%. The lowest prevalence was found among the healthier patients in Cluster I and among the oldest frail patients with severe functional and cognitive impairment in Cluster IV. The highest prevalence was among multimorbid patients in Cluster III (OR=4.50, 95% CI=3.76-5.38) characterized by a high cardiovascular risk. Being prescribed with LLDs was associated with a lower 3-month mortality, even after adjusting for cluster assignment (OR=0.59; 95% CI = 0.44-0.80).

Conclusion

The prevalence of LLD prescription was low and in overall agreement with guideline recommendations and with respect to patients' health state profiles.