Introduction:
The relationship between serum cholesterol and coronary heart disease (CHD) risk is attenuated at older age, making it difficult to estimate risk in this age group.
Hypothesis:
We hypothesized that high sensitivity C-reactive protein (hs-CRP) would identify two subgroups of older individuals (≥65 years): one in whom cholesterol is less predictive of CHD and one in whom it is equally predictive compared to younger individuals.
Methods:
We calculated crude incident rates per 1,000 person-years and used adjusted Cox proportional hazards models to analyze cholesterol as a predictor of CHD in 8,947 participants with no known history of CHD who were stratified by age (53-64 or 65-75 years) and hs-CRP level (<2 or ≥2 mg/L) at baseline.
Results:
Among younger participants, total serum cholesterol was significantly associated with an increased risk of CHD regardless of hs-CRP group HR 1.39 (95% CI 1.20-1.61) for hs-CRP <2 mg/L and HR 1.37 (95% CI 1.22-1.53) for hs-CRP ≥2 mg/L. Among older participants with a low hs-CRP, total cholesterol had a similar association with CHD, HR 1.46 (95% CI 1.24-1.71), as in younger individuals. In contrast, among older individuals with higher hs-CRP, the association of CHD with total cholesterol was attenuated, HR 1.14 (95% CI 1.00-1.29), p-value for interaction = 0.02. Similar trends were observed between age groups and hs-CRP categories for LDL cholesterol.
Conclusions:
Among individuals aged 65-75 years, the association of cholesterol with CHD was strong in those with a low hs-CRP and weak in those with an elevated hs-CRP. Thus, in addition to its use as a risk factor, an elevated hs-CRP could be useful for stratifying the elderly population to aid in the interpretation of serum cholesterol in the prediction of subsequent CHD risk.
C‐Reactive Protein (Crp), Lipid Profile, and Coronary Heart Disease (CHD) Risk in HIV+ Drug Users in Miami
