LDL-C and CV Health Dependent on Age and Specified Endpoint

LDL receptors on cell membrane, illustration. The binding of LDL (low-density lipoprotein) droplets (spherical lipid particles) to the LDL receptors (green/orange, centre) results in the endocytosis of this biochemical molecule through the cell membrane into clathrin-coated vesicles (right-hand side), which are then processed inside the cell. LDL droplets consist of a core of esterified cholesterol molecules surrounded by a shell of unesterified cholesterol and phospholipids. High blood levels of LDL (‘bad’) cholesterol compared to HDL (high-density lipoprotein) cholesterol are thought to raise the risk of atherosclerosis, the build-up of fatty deposits on artery walls. This is a major cause of heart attacks and strokes.
The researchers wanted to determine the value of LDL-C as a risk biomarker for coronary heart disease, atherosclerotic cardiovascular disease, and stroke events and deaths for people stratified by age.

The relationship between low-density lipoprotein cholesterol (LDL-C) concentrations and cardiovascular health depends on age and the specific endpoint. These findings were published in the European Journal of Preventive Cardiology.

Data were sourced from 3 large cohorts FINRISK 2002 (n=7709), HUSK (n=5431), and ESTHER (n=4559). The relationship between LDL-C concentration and cardiovascular endpoints were assessed by researchers at Zora Biosciences Oy.

The FINRISK younger, FINRISK older, HUSK younger, HUSK older, and ESTHER cohorts comprised individuals with a median age of 38, 59, 47, 71, and 62 years; 44%, 47%, 57%, 58%, and 42% were men; and their median LDL-C concentrations were 3.1, 3.5, 3.6, 4.2, and 3.8 mmol/L, respectively.

Significant relationships were observed between LDL-C concentrations and coronary heart disease among the FINRISK (hazard ratio [HR], 1.25; P <.001) and HUSK (HR, 1.13; P =.009) but not ESTHER (HR, 1.06; P =.106) data. An association with coronary heart disease death was observed among the ESTHER cohort (HR, 1.22; P =.021) but not among the FINRISK (HR, 1.13; P =.285) or HUSK (HR, 1.14; P =.255) groups.

For atherosclerotic cardiovascular disease, a significant association was observed among the FINRISK cohort (HR, 1.09; P =.049) but not the HUSK (HR, 1.01; P =.695) or ESTHER (HR, 1.03; P =.293) groups.

No relationship between LDL-C concentration and atherosclerotic cardiovascular disease death or stroke were observed.

Stratified by age, there was a significant association between LDL-C concentration and coronary heart disease death (HR, 1.61; 95% CI, 1.03-2.50; P =.036) and atherosclerotic cardiovascular disease death (HR, 1.56; 95% CI, 1.06-2.30; P =.025) among individuals younger than 50 years.

For older individuals (³50 years), there was a significant association between coronary heart disease (HR, 1.11; 95% CI, 1.04-1.18; P <.001), coronary heart disease death (HR, 1.15; 95% CI, 1.02-1.29; P =.020), and atherosclerotic cardiovascular disease death (HR, 1.12; 95% CI, 1.02-1.23; P =.021) with LDL-C.

These findings may be limited by the fact that fasting protocols before blood draws differed among cohorts.

These data indicated that the relationship between cardiovascular health and LDL-C concentrations depends on the specific endpoint and individual’s age. These features are important to factor into cardiovascular disease risk models.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Hilvo M, Dhar I, Lääperi M, et al. Primary cardiovascular risk prediction by LDL-cholesterol in Caucasian middle-aged and older adults: a joint analysis of three cohorts. Eur J Prev Cardiol. Published online June 1, 2021. doi:10.1093/eurjpc/zwab075

This article originally appeared on The Cardiology Advisor