Low cholesterol may be detrimental to older men not taking statins

Low total cholesterol levels appear to carry increased major adverse cardiovascular events (MACE) hazard in older men without ischaemic heart disease (IHD) and not receiving statin therapy but not to those on statins, according to data from the CHAMP (Concord Health and Ageing in Men Project) cohort.

Researchers followed 1,298 community-dwelling men (mean age, 77 years) for a mean of 6.4 years. Of the participants, 558 were on statin therapy, with atorvastatin (45.9 percent) being the most commonly used, followed by simvastatin (44.3 percent), pravastatin (9.7 percent) and rosuvastatin (0.2 percent).

Most statin users (41.2 percent) were on moderate-intensity doses, while 34.8 percent were on low-intensity and 24.0 percent were on high-intensity doses. Furthermore, participants on statin therapy had lower total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels compared with those not taking statins.

Men with lower TC had higher rates of MACE, mortality, myocardial infarction and congestive cardiac failure. In Cox regression models, decreasing TC level correlated with increased comorbidity burden, frailty and MACE (p-linear trend<0.001).

Among participants not taking statins (n=731), each 1-mmol/L decrease in TC was associated with about a 30-percent increased risk of MACE (hazard ratio [HR], 1.27, 95 percent confidence interval [CI], 1.10–1.45; p=0.001) and mortality (HR, 1.22, 95 percent CI, 1.03–1.44; p=0.02).

Conversely, low TC in men on statins was associated with neither MACE risk (HR, 0.91, 95 percent CI, 0.74–1.11) nor mortality (HR, 0.86, 95 percent CI, 0.68–1.09).

The present data offer reassurance to men aged ≥70 years and taking statins that lower TC or LDL levels exert no unfavourable effect, but suggest that low cholesterol in those not on statins is a risk factor for adverse events.