Age-Related Associations of Low-Density Lipoprotein Cholesterol and Atherosclerotic Cardiovascular Disease: A Nationwide Population-Based Cohort Study

Abstract

BACKGROUND: The relationship between low-density lipoprotein cholesterol (LDL-C) and atherosclerotic cardiovascular disease (ASCVD) according to age remains undetermined. Thus, this study aimed to investigate the age-related association of LDL-C and ASCVD. METHODS AND RESULTS: Data from the Korean NHIS-HEALS (National Health Insurance Service-National Health Screening Cohort) were analyzed. Individuals previously diagnosed with cardiovascular disease or taking lipid-lowering drugs were excluded. Age-specific association between LDL-C and ASCVD was calculated using adjusted Cox proportional hazards models. During a median follow-up of 6.44 years for 285 119 adults, ASCVD developed in 8996 (3.2%). All age groups showed positive associations between LDL-C and ASCVD risk, mostly with statistical significance from LDL-C of 160 mg/dL onward. ASCVD risk did not differ significantly between the age groups (P for interaction=0.489). Correspondingly, subgroup analysis in type 2 diabetes exhibited no difference in the age-specific association of LDL-C and ASCVD (P for interaction=0.784). CONCLUSIONS: The study demonstrated that people aged ≥75 years with higher LDL-C at baseline still presented increased ASCVD risk, which was not significantly different from the younger groups. These findings support the importance of manag-ing LDL-C for the prevention of primary ASCVD in the growing elderly population.