The Association Between Lipid Levels and the Risks of Incident Myocardial Infarction, Stroke, and Total Mortality: The Cardiovascular Health Study

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Abstract
Objectives: To assess the association between lipid levels and cardiovascular events in older adults. Design: A prospective population‐based study. Setting: Four field centers in U.S. communities. Participants: A total of 5,201 adults aged 65 and older living in U.S. communities, plus a recruitment of 687 African Americans 3 years later. Measurements: Fasting lipid measures included low‐density lipoprotein cholesterol (LDL‐C), high‐density lipoprotein cholesterol (HDL‐C), total cholesterol, and triglycerides. Results: At baseline, 1,954 men and 2,931 women were at risk for an incident myocardial infarction (MI) or stroke. During an average 7.5‐year follow‐up, 436 subjects had a coronary event, 332 had an ischemic stroke, 104 a hemorrhagic stroke, and 1,096 died. After adjustment, lipid measures were not major predictors of the outcomes of MI, ischemic stroke, hemorrhagic stroke, and total mortality. For total cholesterol and LDL‐C, the associations with MI and ischemic stroke were only marginally significant. HDL‐C was inversely associated with MI risk (hazard ratio=0.85 per standard deviation of 15.7 mg/dL, 95% confidence interval=0.76–0.96). For the outcome of ischemic stroke, high levels of HDL‐C were associated with a decreased risk in men but not women. Lipid measures were generally only weakly associated with the risks of hemorrhagic stroke or total mortality. Conclusion: In this population‐based study of older adults, most lipid measures were weakly associated with cardiovascular events. The association between low HDL‐C and increased MI risk was nonetheless strong and consistent.