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Harlan M. Krumholz, MD; Teresa E. Seeman, PhD; Susan S. Merrill, PhD; Carlos F. Mendes de Leon, PhD; Viola Vaccarino, MD; David I. Silverman, MD; Reiko Tsukahara, MD; Adrian M. Ostfeld, MD; Lisa F. Berkman, PhD

JAMA. 1994;272(17):1335-1340.

Abstract
Objectives.
—To determine whether elevated serum cholesterol level is associated with all-cause mortality, mortality from coronary heart disease, or hospitalization for acute myocardial infarction and unstable angina in persons older than 70 years. Also, to evaluate the association between low levels of high-density lipoprotein cholesterol (HDL-C) and elevated ratio of serum cholesterol to HDL-C with these outcomes.

Design.
—Prospective, community-based cohort study with yearly interviews.

Participants.
—A total of 997 subjects who were interviewed in 1988 as part of the New Haven, Conn, cohort of the Established Population for the Epidemiologic Study of the Elderly (EPESE) and consented to have blood drawn.

Main Outcome Measures.
—The risk factor—adjusted odds ratios of the 4-year incidence of all-cause mortality, mortality from coronary heart disease, and hospitalization for myocardial infarction or unstable angina were calculated for the following: subjects with total serum cholesterol levels greater than or equal to 6.20 mmol/L (240 mg/dL) compared with subjects with cholesterol levels less than 5.20 mmol/L (<200 mg/dL); subjects in the lowest tertile of HDL-C level compared with those in the highest tertile; and subjects in the highest tertile of the ratio of total serum cholesterol to HDL-C level compared with those in the lowest tertile.

Results.
—Elevated total serum cholesterol level, low HDL-C, and high total serum cholesterol to HDL-C ratio were not associated with a significantly higher rate of all-cause mortality, coronary heart disease mortality, or hospitalization for myocardial infarction or unstable angina after adjustment for cardiovascular risk factors. The risk factor—adjusted odds ratio for all-cause mortality was 0.99 (95% confidence interval [CI], 0.56 to 2.69) for the group who had cholesterol levels greater than or equal to 6.20 mmol/L (240 mg/dL) compared with the group that had levels less than 5.20 mmol/L (<200 mg/dL); 1.00 (95% CI, 0.59 to 1.70) for the group in the lowest tertile of HDL-C compared with those in the highest tertile; and 1.03 (95% CI, 0.62 to 1.71) for subjects in the highest tertile of the ratio of total serum cholesterol to HDL-C compared with those in the lowest tertile.

Conclusions.
—Our findings do not support the hypothesis that hypercholesterolemia or low HDL-C are important risk factors for all-cause mortality, coronary heart disease mortality, or hospitalization for myocardial infarction or unstable angina in this cohort of persons older than 70 years.

(JAMA. 1994;272:1335-1340)

Author Affiliations
From the Section of Cardiovascular Medicine, Department of Internal Medicine (Dr Krumholz), and the Section of Chronic Disease Epidemiology, Department of Epidemiology and Public Health (Drs Krumholz, Seeman, Merrill, Mendes de Leon, Vaccarino, Tsukahara, Ostfeld, and Berkman), Yale University School of Medicine, New Haven, Conn, and the Division of Cardiology, University of Connecticut Medical School, Farmington (Dr Silverman).

Footnotes
Reprint requests to the Section of Cardiovascular Medicine, Yale University School of Medicine, 333 Cedar St, PO Box 208017, New Haven, CT 06520-8017 (Dr Krumholz).

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