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Triglycerides Paradox Among the Oldest Old: “The Lower the Better?”
Author(s) -
Lv YueBin,
Mao Chen,
Gao Xiang,
Yin ZhaoXue,
Kraus Virginia Byers,
Yuan JinQiu,
Zhang Juan,
Luo JieSi,
Zeng Yi,
Shi XiaoMing
Publication year - 2019
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15733
Subject(s) - medicine , hazard ratio , prospective cohort study , confounding , proportional hazards model , confidence interval , gerontology , hypertriglyceridemia , cohort study , demography , activities of daily living , cohort , physical therapy , triglyceride , cholesterol , sociology
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.