High LDL, lower mortality study flawed

Australians should not stop taking medicines to lower blood cholesterol, the Heart Foundation of Australia has reiterated following the publication of a paper suggesting that older people with high LDL cholesterol might live longer.

The paper, Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review, saw researchers search PubMed for cohort studies where LDL (“bad” cholesterol) had been investigated as a risk factor for all-cause and/or CV mortality in individuals aged 60 and over.

They concluded that high LDL-cholesterol was inversely associated with mortality in most people aged over 60.

“This finding is inconsistent with the cholesterol hypothesis (ie, that cholesterol, particularly LDL-C, is inherently atherogenic),” the researchers concluded.

“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.”

The paper has already been criticised by the British Heart Foundation as “unbalanced”. The Foundation cited experts who said the analysis “relied on limited, aggregated and inconsistent information from published sources, an approach liable to bias” and reached “completely the wrong conclusion”.

The authors themselves said they might have overlooked relevant studies as they only searched PubMed and might have excluded studies that evaluated LDL-C as a risk factor for death, the British Heart Foundation pointed out.

Dr Jennifer Johns, Heart Foundation National Board President, told the AJP that as it stands, around half of patients prescribed statins will stop taking them within six months of starting the medicines.

“Poor adherence to a medicine regimen post-heart attack results in a two-to-sixfold increase in the risk of death within a year of the event,” she says.

“Failure to take the medication will lead to unhealthy levels of blood cholesterol, increasing your risk of heart disease including heart attack.

“A third of Australians have high cholesterol, with prevalence highest for those aged 45 and over.”

A study examined the impact of the two-part special edition of Catalyst, Heart of the Matter, which aired in October 2013 and which was followed by a temporary increase in statin discontinuation and a sustained decrease in overall statin dispensing.

“Up until 30 June 2014, there were 504 180 fewer dispensings of statins, and we estimate this to have affected 60 897 people,” this study, which recently won the 2015 MJA, MDA National Prize for Excellence in Medical Research award, concluded.

“Even though the observed effect was relatively small, the prevalence of statin use in Australia and the established efficacy of these drugs mean that a large number of people are affected, and may suffer unnecessary consequences.”

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