Distribution and Correlates of Lipids and Lipoproteins in Elderly Japanese-American Men

Abstract

Adverse lipid and lipoprotein levels are clearly linked with increased risk of cardiovascular disease in middle age, but evidence in elderly and minority populations is less certain. In this study the distribution and correlates of lipids and lipoproteins were evaluated cross-sectionally in 3044 elderly (71 to 93 years) Japanese-American men from the Honolulu Heart Program who were recently reexamined (1991 to 1993). Mean±SD lipid concentrations were 189±33 mg/dL for total cholesterol, 51±13 mg/dL for HDL cholesterol, 109±31 mg/dL for LDL cholesterol, and 147±89 mg/dL for triglycerides. Prevalence of dyslipidemic patterns was relatively infrequent (total cholesterol ≥240 mg/dL: 6.7%; HDL cholesterol <35 mg/dL: 6.4%; LDL cholesterol ≥160 mg/dL: 5.5%; triglycerides ≥200 mg/dL: 18.7%), while prevalence of desirable total (<200 mg/dL) and HDL cholesterol (≥60 mg/dL) concentrations was more common (62.7% and 23.7%, respectively). Mean levels of total cholesterol, LDL cholesterol, and triglyceride decreased significantly with increasing age ( P <.001), while mean HDL cholesterol level increased slightly ( P <.05). After univariate analyses of potential correlates, multiple linear regression models were used to identify variables independently associated with each of the lipids. After adjustment for other variables, levels of fibrinogen and hematocrit were positively associated and insulin, white blood cell count, and use of diabetic medication were negatively associated with total cholesterol. Correlates for LDL cholesterol were similar but also included vital capacity (positive relation) and alcohol (negative relation). Heart rate, physical activity, alcohol, and hematocrit were positively associated with HDL cholesterol; body mass index, subscapular skinfold thickness, glucose, fibrinogen, white blood cell count, and hypertension were negatively associated. Factors associated with triglycerides tended to be similar, yet the direction of relations was reversed. Age-adjusted total cholesterol levels were significantly lower in men who had coronary surgery, thromboembolic stroke, and hemorrhagic stroke but were higher in those with peripheral vascular disease. Lower HDL cholesterol levels were found in men with prevalent angina, angioplasty, definite myocardial infarction, thromboembolic stroke, and peripheral vascular disease. LDL cholesterol and triglycerides showed fewer significant relations with these conditions. Findings indicate that elderly Japanese-American men have a favorable lipid profile, except for elevated triglyceride levels, relative to levels in other populations of older Americans and that a number of cardiovascular risk factors and diseases are strongly associated with lipids in elderly men. These analyses also identify several modifiable factors that may favorably influence lipid and lipoprotein levels in the elderly.