Evidence map›Paper›PMID 27292972›Full record

SynthesisBMJ open2016

Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review.

Uffe Ravnskov, David M Diamond, Rokura Hama, Tomohito Hamazaki, Björn Hammarskjöld, Niamh Hynes, Malcolm Kendrick, Peter H Langsjoen, Aseem Malhotra, Luca Mascitelli and 7 more

Open access · goldAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 152 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
152citing papers in PubMed, 6 pooled it
38.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

152 citing papers in PubMed, 6 syntheses or guidelines pooled it, 352 citations in OpenAlex.

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92 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 13 institutions in 5 countries.

Uffe RavnskovMagle Stora Kyrkogata 9, 22350 Lund, Sweden.
David M DiamondDepartment of Psychology, Department of Molecular Pharmacology and Physiology, Center for Preclinical and Clinical Research on PTSD, University of South Florida, Tampa, Florida, USA.
Rokura HamaNPO Japan Institute of Pharmacovigilance, Osaka, Japan.
Tomohito HamazakiDepartment of Internal Medicine, Toyama Jonan Onsen Daini Hospital, University of Toyama, Toyama City, Japan.
Björn HammarskjöldStrömstad Academy, Strömstad, Sweden.
Niamh HynesWestern Vascular Institute, University Hospital Galway & Galway Clinic, National University of Ireland & Royal college of Surgeons of Ireland affiliated Hospital, Galway, Ireland.
Malcolm KendrickEast Cheshire Trust, Macclesfield District General Hospital, Macclesfield, Cheshire, England.
Peter H LangsjoenSolo Practice in Cardiology, Tyler, Texas 75701, USA.
Aseem MalhotraDepartment of cardiology, Frimley Park Hospital, Portsmouth road, Surrey GU16 7UJ, UK.
Luca MascitelliMedical Service, Comando Brigata Alpina "Julia"/Multinational Land Force, Udine, Italy.
Kilmer S McCullyPathology and Laboratory Medicine Service, VA Boston Healthcare System, West Roxbury; Harvard Medical School, Boston, Massachusetts.
Yoichi OgushiTokai University, Daikancho, Hiratsuka, Kanagawa, Japan 254-0807.
Harumi OkuyamaNagoya City University and Institute for Consumer Science and Human Life, Kinjo Gakuin University, Nagoya, Japan.
Paul J RoschNew York Medical College; The American Institute of Stress.
Tore ScherstenSahlgren's Academy, University of Gothenburg, Sweden, and Colombia University, NY, USA.
Sherif SultanWestern Vascular Institute, University Hospital Galway & Galway Clinic, National University of Ireland & Royal college of Surgeons of Ireland affiliated Hospital, Galway, Ireland.
Ralf SundbergSlottsstadens Läkarhus, Malmö, Gothenburg, Sweden.
American Institute of Physics · USFrimley Park Hospital · GBGalway Clinic · IEHarvard University · USJapan Research Institute · JPMacclesfield District General Hospital · GBMagle (Sweden) · SENagoya City University · JPNational University of Ireland · IETokai University · JPUniversity of Gothenburg · SEUniversity of South Florida · USUniversity of Toyama · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveIt is well known that total cholesterol becomes less of a risk factor or not at all for all-cause and cardiovascular (CV) mortality with increasing age, but as little is known as to whether low-density lipoprotein cholesterol (LDL-C), one component of total cholesterol, is associated with mortality in the elderly, we decided to investigate this issue. SETTING, PARTICIPANTS AND OUTCOME MEASURES: We sought PubMed for cohort studies, where LDL-C had been investigated as a risk factor for all-cause and/or CV mortality in individuals ≥60 years from the general population.

resultsWe identified 19 cohort studies including 30 cohorts with a total of 68 094 elderly people, where all-cause mortality was recorded in 28 cohorts and CV mortality in 9 cohorts. Inverse association between all-cause mortality and LDL-C was seen in 16 cohorts (in 14 with statistical significance) representing 92% of the number of participants, where this association was recorded. In the rest, no association was found. In two cohorts, CV mortality was highest in the lowest LDL-C quartile and with statistical significance; in seven cohorts, no association was found.

conclusionsHigh LDL-C is inversely associated with mortality in most people over 60 years. This finding is inconsistent with the cholesterol hypothesis (ie, that cholesterol, particularly LDL-C, is inherently atherogenic). Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis. Moreover, our study provides the rationale for a re-evaluation of guidelines recommending pharmacological reduction of LDL-C in the elderly as a component of cardiovascular disease prevention strategies.

Indexed as

MortalityAgedCardiovascular DiseasesCholesterol, LDLHumansMiddle AgedRisk FactorsCholesterol, LDLEPIDEMIOLOGYGERIATRIC MEDICINEPREVENTIVE MEDICINERisk factor, LDL-cholesterol, cardiovascular mortality, total mortality, elderly,

Identifiers

PMID27292972
PMCPMC4908872
OpenAlexW2418078838

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.