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P62 Increased serum cholesterol has been found to be a direct  risk factor for coronary heart disease (CHD) in middle aged individuals  in epidemiologic follow-up studies. However, this relationship has not  been consistently reproduced in elderly populations. From 1991-93, 2424  elderly (71-93 years old) Japanese American men from the Honolulu Heart  Program cohort, who did not have prevalent CHD and who were not on  cholesterol lowering drugs, were examined. The subsequent 6-year  follow-up provided an opportunity to closely examine the relationship  between their baseline cholesterol and their incidence of CHD as  determined by surveillance and a physician panel review. The study  revealed a significant non-linear association of the baseline  cholesterol with the incidence of CHD (p=0.033). Among the 1524 elderly  men with cholesterol values below 200mg/dl the age adjusted CHD rate  decreased as the mean cholesterol level increased. In those with  cholesterol levels of greater than or equal to 200mg/dl (900) the age  adjusted CHD rates increased with increasing level of cholesterol. The  lowest CHD rates were seen in men with cholesterol levels between 200  and 219 mg/dl. Multivariate adjustment for other know risk factors  (BMI, smoking, hypertension, diabetes, and HDL), decreased the strength  of this non-linear relationship but it remained significant (p=0.049).  A measure of frailty (10% weight loss since an exam 20 years before)  further reduced the strength of the cholesterol relationship slightly  but did so by reducing the magnitude of the cholesterol/CHD  relationship in both those higher cholesterol (positive relationship)  and those with lower cholesterol (negative relationship). Thus it is  unlikely that frailty can fully explain the reverse cholesterol/CHD  relationship seen in those with lower cholesterol levels. In this study  the majority of men already had cholesterol levels below the standard  cutpoint of 200mg/dl and had the opposite pattern of risk as elderly  men with cholesterols above that cutpoint. This would indicate that  further data is needed before recommending lowering of cholesterol to  levels below 200mg/dl in older individuals.

A Nonlinear Association of Serum Cholesterol Level with Incident Coronary Heart Disease in Elderly Men