Lipoprotein removal mechanisms and aging: implications for the cardiovascular health of the elderly

Curr Opin Endocrinol Diabetes Obes. 2020 Apr;27(2):104-109. doi: 10.1097/MED.0000000000000529.


Purpose of review: The speed of removal from the plasma of apolipoprotein B-containing lipoproteins, for example, chylomicrons, VLDL and LDL is determinant of the plasma concentration of these lipoproteins, is influenced by genetic features and ambient factors, and has implications in atherogenesis. As aging increases the clinical complications of atherosclerosis, it is important to appraise the status of the removal mechanisms in elderly individuals.

Recent findings: Removal of triglyceride-rich lipoproteins remnants is delayed but the triglyceride breakdown is unchanged in elderly individuals. The discovery of PCSK9, enzyme that degrades LDL receptors, and the recent observation that PCSK9 is elevated in the elderly raises another hypothesis to account for the increased LDL-cholesterol levels in the elderly. The removal of cholesterol from cells by HDL, the first step of cholesterol reverse transport is also less efficient in the elderly, which may compromise the body cholesterol homeostasis.

Summary: Aging determines reduction of the efficiency of lipoprotein plasma removal mechanisms, which is implicated in increased incidence of cardia complications. Moreover, aging is frequently accompanied by physical activity reduction, weight gain, and metabolic disturbances that can further decrease the efficacy of the removal mechanisms. This knowledge is important for promoting cardiovascular health in the elderly and prolonging survival.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging / metabolism*
  • Apolipoproteins B / blood
  • Atherosclerosis / etiology
  • Atherosclerosis / metabolism
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / metabolism
  • Cardiovascular System / metabolism
  • Cholesterol / blood
  • Humans
  • Lipid Metabolism / physiology*
  • Lipoproteins / blood
  • Lipoproteins / metabolism*
  • Lipoproteins, LDL / blood
  • Risk Factors


  • Apolipoproteins B
  • Lipoproteins
  • Lipoproteins, LDL
  • Cholesterol