Physicians' Academy for Cardiovascular Education

People aged 70-100 years with elevated LDL-c are at high risk of MI and ASCVD

Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70–100 years: a contemporary primary prevention cohort

Literature - Mortensen MB & Nordestgaard BG., - Lancet. 2020 Nov 21;396(10263):1644-1652. doi: 10.1016/S0140-6736(20)32233-9.

Introduction and methods

LDL-c has been associated with development of atherosclerosis and is the primary treatment target in major guidelines [1,2]. Studies in historical cohorts have shown that the association of increased cholesterol with clinical events disappears in people above the age of 70 years [3-6]. However, these studies were done in cohorts enrolling patients up to 40-50 years ago. Since then, prevention and treatment of atherosclerotic cardiovascular disease (ASCVD) has changed, and life expectancy has increased [7]. This study examined the association of elevated LDL-c with MI and ASCVD risk in a contemporary primary prevention cohort.

Data for this study were obtained from 91,131 individuals enrolled between November 2003 and February 2016 in the Copenhagen General Population Study (CGPS). This cohort reflects the Danish general population aged 20-100 years. Participants and did not have ASCVD or diabetes at baseline and were not taking statins. Risk of MI (fatal and non-fatal) and ASCVD (MI, fatal coronary heart disease, and non-fatal or fatal ischemic stroke) per 1.0 mmol/L increase in LDL-c was determined in the overall population and stratified by age groups (20–49, 50–59, 60–69, 70–79, and 80–100 years). MI and ASCVD event rates per 1000 person-years were determined in individuals stratified by age groups and LDL-c levels (<2.0, 2.0–2.9, 3.0–3.9, 4.0–4.9, and ≥5.0 mmol/L). NNT in 5 years was calculated to estimate the potential effect of LDL-c lowering to prevent one event using moderate-intensity statin therapy in the different age groups (assuming a 30% relative risk reduction for MI and a 22% relative risk reduction of ASCVD). Mean follow-up was 7.7 (SD 3.2) years.

Main results


This study in a contemporary general cohort showed that elevated LDL-c was associated with a higher absolute risk of MI and ASCVD in people aged 70–100 years compared to those aged 20-69 years. Moreover, the estimated NNT in 5 years to prevent one MI or ASCVD event was lower in people aged 70-100 years compared to younger individuals. These results are important for determining preventive strategies aimed at reducing MI and ASCVD events in older adults.


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Watch the video with Prof. Nordestgaard about this study Find this article online at the Lancet

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