1. Am J Hypertens. 2010 Feb;23(2):161-7. Epub 2009 Nov 19.

Combined association of lipids and blood pressure in relation to incident
cardiovascular disease in the elderly: the cardiovascular health study.

Wong ND, Lopez VA, Roberts CS, Solomon HA, Burke GL, Kuller L, Tracy R, Yanez D, 
Psaty BM.

Heart Disease Prevention Program, Division of Cardiology, Department of Medicine,
University of California, Irvine, California, USA. ndwong@uci.edu

BACKGROUND: Hypertension and dyslipidemia are highly prevalent in the elderly. We
studied the combined impact of both conditions on cardiovascular disease (CVD)
events. METHODS: We studied 4,311 participants aged 65-98 (61.2% female) from the
Cardiovascular Health Study (CHS), a longitudinal epidemiologic study, with no
prior CVD. We evaluated the relation of low-density lipoprotein (LDL),
high-density lipoprotein (HDL), or non-HDL-cholesterol combined with blood
pressure (BP) categories to incident CVD-including coronary heart disease (CHD)
(angina, myocardial infarction (MI), angioplasty, coronary bypass surgery, or CHD
death), stroke, claudication, and CVD death over 15 years. RESULTS: CVD incidence
(per 1,000 person years) ranged from 38.4 when BP <120/80 mm Hg and LDL-C <100
mg/dl to 94.8 when BP >or=160/100 mm Hg and LDL-C >or=160 mg/dl, and from 28.9
when BP <120/80 mm Hg and HDL >60 mg/dl to 87.1 for a BP >or=160/100 and HDL-C
<40 mg/dl. Compared with those with BP <120/80 mm Hg with either LDL-C <100 mg/dl
or HDL-C >60 mg/dl, hazard ratios (HRs) for CVD events were 2.1 when BP
>or=160/100 mm Hg and LDL-C >or=160 mg/dl and 2.1 when BP >or=160/100 and HDL-C
<40 mg/dl (all P < 0.01), with similar results for non-HDL-C. Elevated BP was
associated with increased risk across all lipid levels. Increased LDL-C added
risk mainly when BP <140/90 mm Hg, but lower HDL-C also predicted CVD in those
with higher BP. CONCLUSION: Increased BP confers increased risks for CVD in
elderly persons across all lipid levels. Although increased LDL-C added risk
mainly when BP <140/90 mm Hg, low HDL-C added risk also in those with
hypertension. These results document the importance of combined hypertension and 

PMID: 19927131 [PubMed - in process]