Serum Cholesterol as a Risk Factor: Effects of Gender and Age

Prior to the age of 65 years, in “middle age”, the relation between coronary heart disease (CHD) and total serum cholesterol (TC) is at least as strong in women as in men in terms of relative risk, indicating that elevated levels carry similar atherogenicity in the two genders. Attributable risk, on the other hand, is less in women than men because their absolute CHD risk is lower. Thus, preventive measures in middle age will benefit relatively fewer women than men during this period of life. Elderly women show an increase in relative risk due to elevated TC less consistently than men but their attributable risk is higher than for men beyond the age of 65 years. Therefore, older women potentially derive much benefit from prevention. Low-density lipoprotein cholesterol (LDL-C) is no more predictive for CHD than TC but HDL-C has independent predictive value in elderly women and men. The TC/HDL-C ratio is more strongly related to CHD risk than TC in either gender and at any age. However, TC remains significantly predictive in elderly men and, if allowance is made for competing risks, in elderly women so that there would be no scientific basis for putting an age limit on TC reduction in either men or women, taking additionally the large attributable risks into account.