PT - JOURNAL ARTICLE AU - Sonali Rukshana Gnanenthiran AU - Austin C C Ng AU - Robert Cumming AU - David B Brieger AU - David Le Couteur AU - Louise Waite AU - David Handelsman AU - Vasi Naganathan AU - Leonard Kritharides AU - Fiona Blyth TI - Low total cholesterol is associated with increased major adverse cardiovascular events in men aged ≥70 years not taking statins AID - 10.1136/heartjnl-2019-315449 DP - 2020 May 01 TA - Heart PG - 698--705 VI - 106 IP - 9 4099 - http://heart.bmj.com/content/106/9/698.short 4100 - http://heart.bmj.com/content/106/9/698.full SO - Heart2020 May 01; 106 AB - 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.