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Original research
Low total cholesterol is associated with increased major adverse cardiovascular events in men aged ≥70 years not taking statins
  1. Sonali Rukshana Gnanenthiran1,2,
  2. Austin C C Ng1,2,
  3. Robert Cumming3,4,5,
  4. David B Brieger1,
  5. David Le Couteur2,3,5,
  6. Louise Waite3,
  7. David Handelsman2,
  8. Vasi Naganathan3,5,
  9. Leonard Kritharides1,2,
  10. Fiona Blyth4,5
  1. 1 Cardiology Department, Concord Repatriation General Hospital University of Sydney, Sydney, New South Wales, Australia
  2. 2 Anzac Research Institute, Concord Repatriation General Hospital, Sydney, NSW, Australia
  3. 3 Centre for Education and Research on Ageing Faculty of Medicine and Health, University of Sydney, NSW, Australia and Ageing and Alzheimer’s Institute, Concord Repatriation General Hospital, University of Sydney Ageing and Alzheimer’s Institute Concord Repatriation General Hospital, Concord, New South Wales, Australia
  4. 4 School of Public Health Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  5. 5 Concord Clinical School Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Professor Leonard Kritharides, Cardiology, Concord Hospital, Concord West, NSW 2139, Australia; leonard.kritharides{at}; Dr Sonali Rukshana Gnanenthiran, Cardiology, Concord Hospital, Concord West 2139, NSW, Australia; sonali.gnan{at}


Objective Low levels of total cholesterol (TC) are associated with adverse outcomes in older populations. Whether this phenomenon is independent of statin use is unknown. We investigated the association between low TC levels and long-term major adverse cardiovascular events (MACE) in a prospective study of men aged ≥70 years without ischaemic heart disease (IHD) and whether this was influenced by statin use.

Methods The CHAMP (Concord Health and Ageing in Men Project) cohort is a prospective cohort study of community-dwelling men aged ≥70 years. The relationship between TC and long-term MACE was analysed using Cox-regression modelling adjusted for comorbidities and stratified by statin use.

Results The study cohort comprised 1289 men (mean (±SD) age, 77.0±5.5 years; mean follow-up, 6.4±2.7 years). Decreasing TC level was associated with increased comorbidity burden, frailty and MACE (linear trend p<0.001). In men not on statin therapy (n=731), each 1 mmol/L decrease in TC was associated with increased MACE (HR 1.27, 95% CI 1.10 to 1.45, p=0.001) and mortality (HR 1.22, 95% CI 1.03 to 1.44, p=0.02) adjusted for comorbidities. In contrast, low TC in men on statins (n=558) was not associated with MACE (HR 0.91, 95% CI 0.74 to 1.11) or mortality (HR 0.86, 95% CI 0.68 to 1.09).

Conclusion Low TC is associated with increased risk of MACE in older men without IHD who are not taking statin therapy but not in those on statins.

  • lipoproteins and hyperlipidemia
  • epidemiology

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  • LK and FB are joint senior authors.

  • Contributors All authors have read and approved this manuscript. All authors contributed to the paper. SRG, ACCN and LK were involved in the planning, data analysis and writing of the manuscript. RC, DBB, DLC, LW, DH, VN and FB were involved in the planning and writing of the manuscript.

  • Funding The CHAMP study was supported by the National Health and Medical Research Council (project grant no. 301916), Australia and the Ageing and Alzheimer’s Institute, Australia.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The study was approved by the institutional Research Ethics Committee (Sydney Local Health District).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.