The association between lipid levels and the risks of incident myocardial infarction, stroke, and total mortality: The Cardiovascular Health Study

J Am Geriatr Soc. 2004 Oct;52(10):1639-47. doi: 10.1111/j.1532-5415.2004.52455.x.


Objectives: To assess the association between lipid levels and cardiovascular events in older adults.

Design: A prospective population-based study.

Setting: Four field centers in U.S. communities.

Participants: A total of 5,201 adults aged 65 and older living in U.S. communities, plus a recruitment of 687 African Americans 3 years later.

Measurements: Fasting lipid measures included low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol, and triglycerides.

Results: At baseline, 1,954 men and 2,931 women were at risk for an incident myocardial infarction (MI) or stroke. During an average 7.5-year follow-up, 436 subjects had a coronary event, 332 had an ischemic stroke, 104 a hemorrhagic stroke, and 1,096 died. After adjustment, lipid measures were not major predictors of the outcomes of MI, ischemic stroke, hemorrhagic stroke, and total mortality. For total cholesterol and LDL-C, the associations with MI and ischemic stroke were only marginally significant. HDL-C was inversely associated with MI risk (hazard ratio=0.85 per standard deviation of 15.7 mg/dL, 95% confidence interval=0.76-0.96). For the outcome of ischemic stroke, high levels of HDL-C were associated with a decreased risk in men but not women. Lipid measures were generally only weakly associated with the risks of hemorrhagic stroke or total mortality.

Conclusion: In this population-based study of older adults, most lipid measures were weakly associated with cardiovascular events. The association between low HDL-C and increased MI risk was nonetheless strong and consistent.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • African Americans
  • Aged
  • Blacks
  • Female
  • Health Surveys
  • Humans
  • Incidence
  • Lipids / blood*
  • Male
  • Mortality*
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / etiology*
  • Population Surveillance / methods*
  • Prospective Studies
  • Risk Factors
  • Stroke / epidemiology
  • Stroke / etiology*
  • United States / epidemiology


  • Lipids