Total Cholesterol and Mortality in Older Adults: A Sex-Stratified Cohort Study

Strategic Insights -

Researchers have revealed a complex relationship between total cholesterol levels and mortality in older adults, with findings that contradict the conventional understanding that hypercholesterolemia is a known risk factor in midlife. The study, published in Nutrients, used data from the InCHIANTI study, a longitudinal, population-based study conducted in Tuscany, Italy, and found that in older adults, particularly women, low total cholesterol levels may signal underlying vulnerability, including malnutrition or inflammation.

Key Takeaways:

  • The relationship between total cholesterol levels and mortality in older adults is complex and may differ from younger populations.
  • Hypercholesterolemia is a known midlife risk factor, but its association with mortality may weaken or reverse with age.
  • Biological differences in cholesterol metabolism, particularly hormonal changes, may contribute to sex-specific mortality risks, but this remains underexplored.
  • The study used data from the InCHIANTI study, a longitudinal, population-based study conducted in Tuscany, Italy, which included 999 participants aged 65 years with baseline total cholesterol and mortality data.
  • Total cholesterol levels were categorized into five groups: 340 mg/dL.
  • The study found that in older adults, particularly women, low total cholesterol levels (<160 mg/dL) may signal underlying vulnerability, including malnutrition or inflammation.
  • The research suggests that total cholesterol levels should be interpreted in the context of sex-specific mortality risks, and further research is needed to explore the underlying mechanisms.
  • The study highlights the importance of considering sex-specific differences in cholesterol metabolism and mortality risk in older adults.

Statistics:

  • The study included 1453 participants from the original InCHIANTI cohort, with 999 participants aged 65 years included in the analysis.
  • The participants had a mean age of 73.2 years (SD 6.4) and a mean total cholesterol level of 216.4 mg/dL (SD 47.8).
  • The study found that the prevalence of low total cholesterol levels (<160 mg/dL) was higher in women (14.1%) than in men (6.5%).
  • The study found that the risk of all-cause mortality was higher in women with low total cholesterol levels (<160 mg/dL) than in men with similar levels.
  • The research suggests that total cholesterol levels <160 mg/dL may signal underlying vulnerability, including malnutrition or inflammation, in older adults, particularly women.

Sources:

  • Total Cholesterol and Mortality in Older Adults: A Sex-Stratified Cohort Study. Nutrients, 2025;17(19):3128.
  • InCHIANTI study: a longitudinal, population-based study conducted in Tuscany, Italy.
  • Mdpi: St Alban-Anlage 66, Ch-4052 Basel, Switzerland.
  • Diana Lelli, Research Unit of Geriatrics, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy.
  • Additional authors: Maria Serena Iuorio, Stefania Bandinelli, Luigi Ferrucci, Claudio Pedone, and Raffaele Antonelli Incalzi.