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Old 01-09-2006, 09:47 AM   #1
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Low LDL Cholesterol May Not Benefit the Elderly

More confirmation that a low LDL is not aways a good thing for the over 65 year olds is highlighted in a report in The Journal of the American Geriatric Society .

A study involving 3,120 men and women over 12 years is reported on at:

[url]WWW.nlm.nih.gov/medlineplus/news/fullstory_28974.html[/url]

 
Old 01-10-2006, 06:56 AM   #2
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Arrow Re: Low LDL Cholesterol May Not Benefit the Elderly

Quote:
NEW YORK (Reuters Health) - LDL cholesterol is known as the "bad" cholesterol, because high levels are linked to heart disease, but low levels may not be good for the elderly.
A new study of older men and women shows that higher LDL cholesterol levels are associated with decreasing mortality risk in women. For both men and women, the risk of fatal heart failure decreases with higher LDL cholesterol levels.

The findings "add to the uncertainty of the role of elevated levels of LDL cholesterol as a risk factor for mortality in old people," according to the researchers who conducted the study.

Dr. Valerie Tikhonoff of the University of Padua, Italy, and colleagues conducted a population-based study of 3120 subjects age 65 years or older, who were followed for up to 12 years.

Tikhonoff''s group reports in the Journal of the American Geriatric Society that the likelihood of dying during the follow-up period "was curvilinear ... decreasing nonlinearly with LDL cholesterol."

The total mortality risk in relation to LDL level was J-shaped in men, meaning that the risk increased as LDL cholesterol levels fell below a mid range -- although the risk increased with high levels of LDL.
Similarly, there was a J-shaped relationship to the risk of dying from cardiovascular causes for both sexes, and for the risk of having a fatal heart attack among men.

"The key finding of this study was that, in older subjects with a low use of lipid-lowering drugs representative of the general Italian population, serum LDL cholesterol behaved as a multifaceted and predominantly nonlinear predictor of cardiovascular and all-cause mortality," Tikhonoff and colleagues conclude.

They add that results of lipid-lowering drug trials should be interpreted with caution in unselected elderly patients, because these findings contradict the usual association of high LDL cholesterol with mortality risk seen in younger patients.
Intriguing article liverock.
Unfortunately, that's all we can get without paying $48.99 for the article. Alas.
A couple thoughts, since we are dealing here with a sample of people who are dying largely in their 70's the skewing effects of cancer cannot be ruled out. Low cholesterol levels are a familaiar accompaniment to the cachexia of cancer and occurs even much earlier in the cancer process.
IF the 3,120 people were followed for "up to 12 years" it would be nice to know how many died and what they died of. I would also LOVE to know what the bottom of that J-curve for LDL was for men at which point deaths started increasing with LDL.
For women they are saying a J-shaped relationship (high LDL continues to kill) with regards to heart disease...but NOT for all-mortality. THat indicates to me the point where cancer deaths are showing up in the lower LDL women as expected.
A final point is that of all populations, Italians stand the greatest chance of having the Milano gene that protects against the effect of high LDL; those with the gene have almost no chance of developing heart disease, no matter what.
Can we assume that none of the people were treated with cholesterol lowering drugs????
And damn, WHAT was the J-point LDL level reading! D! My curiosity is going to kill me. I think the NYPL probably has the journal, maybe eventually I'll get the number.

Here's the ABSTRACT from the journal:
Quote:
Objectives:

To investigate the role of low-density lipoprotein cholesterol (LDL-C) as a predictor of mortality in elderly subjects. Design:

Population-based prospective cohort study. Setting:

Two communities in northern Italy. Participants:

Three thousand one hundred twenty Caucasian subjects aged 65 and older recruited in for the Cardiovascular Study in the Elderly and followed up for 12 years. Measurements:

Anthropometric measures: fasting plasma total cholesterol, triglyceride, high-density lipoprotein cholesterol, LDL-C, glucose, creatinine, and body mass index. Clinical measures: medical assessment, diabetes mellitus, hypertension, stroke, coronary disease, heart failure, and smoking and drinking habits. Vital status measures: death certificates from the Registry Office and causes of death according to the International Classification of Diseases. After plotting mortality rates using quartiles of LDL-C, relative hazard rates (RHRs) were calculated using multivariate Cox regression analyses. When the trend was nonlinear, the RHRs were further calculated for the 25th, 50th, and 75th percentiles of the distribution to confirm curvilinearity. Results:

The distribution of risk of total mortality in women and of fatal heart failure in all subjects was curvilinear (non J-shaped), decreasing nonlinearly with LDL-C. For total mortality in men and cardiovascular mortality in both sexes, the relationship with LDL-C was J-shaped. The risk of fatal myocardial infarction was J-shaped in men, whereas it increased linearly with higher LDL-C in women. In both sexes, the association between stroke mortality and LDL-C was not significant. Conclusion:

This study adds to the uncertainty of the role of elevated levels of LDL-C as a risk factor for mortality in old people.
And then in Medscape:
Quote:
Dr. Tikhonoff's group found that "the distribution of risk of total mortality in women and of fatal heart failure in all subjects was curvilinear (non-J-shaped), decreasing nonlinearly with LDL cholesterol."

The risk of total mortality with LDL level was J-shaped in men; the risk of cardiovascular mortality was J-shaped for both sexes; and the risk of fatal MI was J-shaped in men and increased linearly in women. LDL cholesterol was not a significant factor in stroke mortality in either sex.
Am I reading this wrong or does it indeed say that "the risk of fatal MI increased linearly (presumably with LDL) in women"...and thus means that the common wisdom holds, that increasing LDL causes more fatal heart attacks (in women of any age?)

GOOD:
I located the article in the Mid-Manhattan branch of the NYPL...I'll get in on Friday and Xerox it.

Last edited by Lenin; 01-10-2006 at 07:48 AM.

 
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Old 01-10-2006, 03:57 PM   #3
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Re: Low LDL Cholesterol May Not Benefit the Elderly

low cholesterol typically means low levels of DHEA and other hormones, which is an issue for older people as they provide many health benefits.

its the whole too much.. too little.. of what is a necessary substrate...

 
Old 01-10-2006, 06:47 PM   #4
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Re: Low LDL Cholesterol May Not Benefit the Elderly

I heard on Health Watch that older women are better off with high ldl because it helps prevent strokes. this is all too confusing to me. I say just eat your food and be happy.Be sure to eat unprocessed foods, exercise and don't smoke ant maybe we'll all just make it.

Some ppl never get these problems b4 going on other kinds of meds. My mom never had a cholesterol or thyroid problem until she started on beta blockers and ace inhibitors. Now it is a constant battle. Just live your life! imho

 
Old 01-10-2006, 07:06 PM   #5
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Re: Low LDL Cholesterol May Not Benefit the Elderly

Quote:
Originally Posted by lane413
I heard on Health Watch that older women are better off with high ldl because it helps prevent strokes. this is all too confusing to me. I say just eat your food and be happy.Be sure to eat unprocessed foods, exercise and don't smoke ant maybe we'll all just make it.

Some ppl never get these problems b4 going on other kinds of meds. My mom never had a cholesterol or thyroid problem until she started on beta blockers and ace inhibitors. Now it is a constant battle. Just live your life! imho

They keep changing their minds so often, I often wonder if they actually know themselves, and are we just guinea pigs? Hubby's cardio man says it best, eat in moderation, try to eat properly and exercise, and if ANY med. takes your quality of life away, it is doing U more harm then good. Yes, he prescribes statins, but will not force a person with nasty side effects to continue with them.

Seems they give U one med for one thing, then have to prescribe something else to counteract that med..a TOTAL vicious cycle sometimes. JMHO

Last edited by JJ; 01-10-2006 at 07:07 PM.

 
Old 01-11-2006, 09:35 AM   #6
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Re: Low LDL Cholesterol May Not Benefit the Elderly

Quote:
Originally Posted by Lenin
Intriguing article liverock.
Unfortunately, that's all we can get without paying $48.99 for the article. Alas.
A couple thoughts, since we are dealing here with a sample of people who are dying largely in their 70's the skewing effects of cancer cannot be ruled out. Low cholesterol levels are a familaiar accompaniment to the cachexia of cancer and occurs even much earlier in the cancer process.
IF the 3,120 people were followed for "up to 12 years" it would be nice to know how many died and what they died of. I would also LOVE to know what the bottom of that J-curve for LDL was for men at which point deaths started increasing with LDL.
For women they are saying a J-shaped relationship (high LDL continues to kill) with regards to heart disease...but NOT for all-mortality. THat indicates to me the point where cancer deaths are showing up in the lower LDL women as expected.
A final point is that of all populations, Italians stand the greatest chance of having the Milano gene that protects against the effect of high LDL; those with the gene have almost no chance of developing heart disease, no matter what.
Can we assume that none of the people were treated with cholesterol lowering drugs????
And damn, WHAT was the J-point LDL level reading! D! My curiosity is going to kill me. I think the NYPL probably has the journal, maybe eventually I'll get the numbers
Lenin

I tried the Geriatric Society site they only wanted $39 ! I wasnt tempted, my experience is 8 times out of 10 if its not in the abstract your probably not going to be any the wiser after reading the whole report.

As far as the Milano gene is concerned it only affected a small population in Northern Italy and I would hope that an Italian researcher would make sure that none of the subjects in the trial had the gene.

Incidentally clinical trials are going ahead after animal studies were successful in injecting the gene in mice and getting complete plaque reversal. If the trial is successful this forum will be redundant(along with 90% of cardiologists)

Regarding the low cholesterol/cancer point, I'm not convinced that the majority of cases of low cholesterol in elderly people are the result of cancer, certainly not in the case of poor old Nathan Pritikin who had a TC of 102 for 20 years before he got cancer at 69 and committed suicide,another alleged side effect of low cholesterol.

Just to throw more fuel on the fire a report based on the Framingham data at [url]www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_u ids=8481074&dopt=Abstract[/url]

Total Serum Cholesterol Levels and Mortality Risk as a Function of Age

reported that even allowing for disease caused low cholesterol levels, lowering levels for over 65 year olds was not shown to be effective in mortality risk.

Good luck in your search for the magical J curve LDL figure !

Last edited by liverock; 01-11-2006 at 12:34 PM.

 
Old 01-12-2006, 06:38 AM   #7
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Re: Low LDL Cholesterol May Not Benefit the Elderly

Liverock,

Certainly true that nobody could make the mistake of ascribing most or all of the cases of low LDL in the elderly to cancer.
BUT if one looks at a treatment for heart disease, the #1 killer, and then if "all case mortality" numbers giving one result and "death from heart disease" as another, it is likely that that the difference is very likely ascribable to the number 2 killer, cancer.
After all, if one escapes death from heart disease, one is VERY likely to die of cancer thus the low LDLers that escape heart disease WILL usually die from cancer, it's demographics...and thus the low LDL at the end of life might very confidently be caused by cancer, diagnosed yet or not. Certainly whatever people DID die of cancer in this backward-looking study, skewed the results, perhaps considerably.


That's why I HATE using "death from all causes" except perhaps when one is initially evaluating a new drug for safety.

It would be akin to a drug that CURED ALL CANCERS. When viewed demographically, you'd HAVE to find that a huge proportion of the people taking the wonder drug died from heart disease. That would be no good reason to view the cancer drug in a poor light. It's just that we all, unfortunately, have to die of something and the two front-runners are cancer and heart disease. Those that really win the game are those who make it to the next plateau: stroke, liver failure, end-stage kidney disease, and Alzheimer's ...Oh the joy of it all!

Last edited by Lenin; 01-12-2006 at 06:50 AM.

 
Old 01-12-2006, 09:39 AM   #8
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Re: Low LDL Cholesterol May Not Benefit the Elderly

Quote:
Originally Posted by Lenin
Liverock,

It's just that we all, unfortunately, have to die of something and the two front-runners are cancer and heart disease. Those that really win the game are those who make it to the next plateau: stroke, liver failure, end-stage kidney disease, and Alzheimer's ...Oh the joy of it all!

Thankyou for that Lenin, I am now feeling quite depressed.

On a brighter note I have got a representative of a leading medical insurance company to answer a few queries and extend my knowledge of the system.

MEDICAL INSURANCE EXPLAINED

Q. Thankyou for agreeing to answer my questions.
A. Not at all, medical insurance is simple.

Q. What does HMO stand for?

A. This is actually a variation of the phrase, "HEY MOE". Its roots go back to a concept pioneered by Moe of the Three Stooges, who discovered that a patient could be made to forget the pain in his foot if he was poked hard enough in the eye.

Q If I just joined an HMO how difficult would it be to choose the doctor I want?

A.Just slightly more difficult than choosing your parents. Your insurer will provide you with a book listing all the doctors in the plan. The doctors basically fall into two categories: those who are no longer accepting new patients and those who will see you but are no longer part of the plan.
But don't worry, the remaining doctor who is still in the plan and accepting new patients has an office just a half-day's drive away and a diploma from a third world country.

Q. Do all diagnostic procedures require pre-certification?
A. No. Only those you need.

Q.Can I get coverage for my pre-existing conditions?
A. Certainly, as long as they dont require any treatment.

Q. What happens if I want to try alternative forms of medication?
A. You'll need alternative forms of payment.

Q.My pharmacy plan only covers generic drugs but I need the name brand. I tried the generic medicine but it gave me stomach ache. What should I do?
A. Poke yourself in the eye.

Q.What if I'm away from home and I get sick?
A.You really shouldn't do that.

Q. I think I need to see a specialist, but my doctor insists he can handle the problem. Can a GP really perform a heart transplant right in his/her office?
A. Hard to say, but considering that all your risking is the $20 co-payment, there's no harm in giving it a shot.

Q.I note in your publicity you say you always give your customers more. Can you explain?
A.Certainly. We have more fine print conditions, more exclusions and more claim disputes. As we say we always give our customers more.

Q. Thankyou for answering my questions.
A. Not at all. As I said medical insurance is simple.

Last edited by liverock; 01-12-2006 at 01:29 PM.

 
Old 01-12-2006, 09:59 AM   #9
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Re: Low LDL Cholesterol May Not Benefit the Elderly

Liverock...THANK U for starting my day off with a good laugh. Just a shame that just about all of what U said is true.

Have a great day, and keep those laughs coming......

 
Old 01-12-2006, 03:13 PM   #10
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Re: Low LDL Cholesterol May Not Benefit the Elderly

ROFL,

Thank you for that delicious tidbit that shall be sent round the world posthaste.
It would have been even funnier if every word hadn't been the gospel truth!

 
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