Low-density lipoprotein cholesterol, coronary plaque burden, and myocardial infarction in adults aged 76–92 years: the Western Denmark Heart Registry

AIMS: The role of low-density lipoprotein cholesterol (LDL-C) in atherosclerotic cardiovascular disease in individuals aged >75 remains controversial. This study aimed to assess whether LDL-C levels are associated with coronary plaque burden and future myocardial infarctions (MI) in individuals across different ages, with focus on those aged 76-92. METHODS: This contemporary cohort study included symptomatic statin-naïve individuals who underwent coronary computed tomography angiography (CCTA) from 2008-2021, from the Western Denmark Heart Registry. Outcomes included 1) adjusted risk ratio (aRR) for CAC >90th percentile, 2) aRR for post-CCTA revascularization within 90 days of CCTA, indicating advanced atherosclerotic disease, and 3) adjusted hazard ratio (aHR) for MI. RESULTS: The study included 37,910 individuals, of whom 1,562 were aged 76-92. A total of 433 individuals experienced MI during a median follow-up time of 5.1 years. Higher LDL-C levels were associated with higher risk of CAC >90th percentile, post-CCTA revascularization, and MI across all age groups. In individuals aged 76-92, the aRRs per 1 mmol/L higher LDL-C for CAC >90th percentile and for post-CCTA revascularization were 1.19 (95% CI: 1.00-1.40) and 1.41 (1.22-1.64); corresponding values at age 61-75 years were 1.07 (1.01-1.14) and 1.32 (1.23-1.41), respectively. At age 76-92 and 61-75 years, the aHRs for MI were 1.57 (1.06-2.32) and 1.22 (1.03-1.44) per 1 mmol/L higher LDL-C. CONCLUSION: In statin-naïve symptomatic individuals aged 76-92, higher LDL-C was associated with CAC >90th percentile, post-CCTA revascularization, and increased risk of MI. These findings suggest that elevated LDL-C is a driver of coronary artery disease throughout life.