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© 1997 American Heart Association, Inc.
Articles |
Effect of Serum Lipids, Lipoproteins, and Apolipoproteins on Vascular and Nonvascular Mortality in the Elderly
From the Department of Geriatrics, University of Turku, Turku, Finland (I.R., L.S.); the Research and Development Centre of the Social Insurance Institution, Turku, Finland (J.M., P.P., T.T.); and the Department of Biochemistry, National Public Health Institute, Helsinki, Finland (C.E.).
Correspondence to I. Räihä, Department of Geriatrics, University of Turku, Kunnallissairaalantie 20, FIN-20700 Turku, Finland.
Abstract The purpose of this study was to determine the
effect of serum lipids, lipoprotein fractions, and apolipoprotein (apo)
A-1, B, and E on mortality from vascular and nonvascular causes in an
unselected elderly population. The random sample of 347
community-living individuals aged 65 years or older was obtained in
1982. Serum total cholesterol, LDL cholesterol
(LDL-C), HDL cholesterol (HDL-C), triglyceride,
and apo A-1, B, and E were determined at baseline. After the 11-year
follow-up, 199 of the participants had died, and 148 were still alive.
Mortality data from vascular and nonvascular causes by the end of 1993
were obtained from official registers. In the univariate
analysis, a low total cholesterol level was
associated with death due to both vascular and nonvascular causes
(P value for trend, .021 and .0027, respectively). After the
adjustment for other risk factors, the inverse association between
total cholesterol and vascular mortality disappeared, but
low total cholesterol was still a significant predictor of
death due to nonvascular causes. Adjusted relative risks (RRs) of death
due to nonvascular causes for those with elevated total
cholesterol (5.1 to 6.5, 6.6 to 8.0, and >8.0 mmol/L)
compared with the reference group (
5.0 mmol/L) were 0.5 (95%
confidence interval [CI], 0.2 to 1.2), 0.6 (0.2 to 1.0), and 0.2 (0
to 0.8), respectively. Neither concentrations of HDL-C, LDL-C,
triglyceride, nor apo B were associated with vascular or
nonvascular mortality. On the other hand, low concentration of apo A-1
predicted vascular death. The RR for the lowest tertile was 1.6 (1.1 to
2.5) compared with the highest tertile. Furthermore, the occurrence of
the apo E e4 allele was associated with increased risk of vascular
mortality (RR, 1.5; 95% CI, 1.0 to 2.2), but the risk was not related
to the levels of lipids, lipoproteins, or other apolipoproteins at
baseline. Nonvascular mortality also tended to be predicted by the
presence of the e4 allele (RR, 1.5; 95% CI, 0.9 to 2.5). In an
unselected elderly population, the allelic variation of apo E, ie, the
presence of the e4 allele, and a low concentration of apo A-1 were
more accurate indicators of vascular mortality than total
cholesterol or lipoprotein fractions. The risk associated
with the apo E polymorphism is unrelated to
dyslipidemia.
Key Words: apolipoprotein A-1 • apolipoprotein E • cholesterol • coronary heart disease • elderly • mortality • prognosis
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