Predictors of falling cholesterol levels in older adults: the cardiovascular health study

Purpose To estimate 4-year change in serum total cholesterol levels in a population-based sample of older adults and identify independent predictors of cholesterol decline. Methods Prospective study of 2837 adults aged 65 years and older with serum cholesterol measured in 1992–1993 and 1996–1997. Results Mean serum cholesterol levels declined 6.3 mg/dl between the two examinations. Declines were greater in white (−7.3 mg/dl) than black (−1.4 mg/dl) participants and in those in good/excellent health (−0.9 mg/dl) vs. fair/poor health (−3.1 mg/dl; both p < 0.01). Factors associated with greater decline on multivariate analysis included age, male gender, and higher white cell count, albumin, and baseline cholesterol. Cholesterol levels declined 2.0 mg/dl per 6 year increment in baseline age and 6.8 mg/dl more in men than women after adjustment for other factors. C-reactive protein levels were unrelated to cholesterol change. Conclusion Declining cholesterol levels were associated with male gender, advanced age, weight loss, and white blood cell count but not with C-reactive protein levels. The role of declining cholesterol synthesis, due to as yet undefined age-related changes or to cytokine-mediated reductions related to illness, should be examined to help clarify the mechanisms of the sometimes marked declines in cholesterol levels observed at advanced ages.