Is a high serum cholesterol level associated with longer survival in elderly hypertensives?

Abstract

The relationship between serum total cholesterol, measured at randomization, and mortality was investigated in 822 patients, who were followed for an average of 3.1 years in a double-blind trial, conducted by the European Working Party on High Blood Pressure in the Elderly. Serum cholesterol, measured at randomization, was 0.54 mmol/l higher in women than in men, and declined with increasing age in both men (0.028 mmol/l per year) and women (0.036 mmol/l per year). During follow-up on randomized treatment, cholesterol fell by a similar amount with placebo (0.11 mmol/l per year) and with active treatment (0.14mmol/l per year). Active treatment consisted of hydrochlorothiazide (25-50 mg/day) plus triamterene (50-100 mg/day) with the addition of a-methyldopa (0.5-2.0 g/day) in one-third of the patients. Serum total cholesterol, measured at randomization, was independently and inversely correlated with total (P = 0.03), non-cardiovascular (P = 0.03) and cancer (P = 0.04) mortality during follow-up on double-blind treatment. Total and non-cardiovascular mortality were also negatively correlated with haemoglobin and body weight at randomization. All factors being equal, an increase in serum total cholesterol by 2.3 mmol/l was associated with a 1-year prolongation of survival. However, after adjustment for gender, age, cardiovascular complications and systolic blood pressure at randomization, the correlations between serum cholesterol and cardiovascular and cardiac mortality were not significant. In conclusion, a high serum total cholesterol level is associated with longer survival in elderly hypertensives. This can be explained by the association of lower non-cardiovascular mortality with high serum cholesterol, and by the absence of a positive relationship in this population between cholesterol and cardiovascular mortality. However, recommendations for disease prevention must not be changed in the light of the present findings. © Current Science Ltd.