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Background

In recent years a marked reduction in mortality in later life

has been observed. In conjunction with longer life expectancy

this has led to a steady growth of this segment of the population

(the oldest old), although within this group striking inter-

individual differences in life expectancy remain (1). The

characteristics of this population group therefore need to be

explored further in order to determine the causes of morbidity

and mortality.

One recent report found that the prevalence of

dyslipidaemia, a prevalent cardiovascular risk factor, was not

lower among the oldest old (2). At all events, an importantaspect to consider is that different epidemiological studies have

confirmed that, as in the adult population, low levels of serum

high-density lipoprotein cholesterol (HDL-C) remain a strong

risk factor for cardiovascular disease in the elderly (3, 4).

Moreover, low HDL-C levels have been associated with an

increased risk of stroke in the Leiden cohort (people over 85

years of age) (5), as well as with higher overall mortality in the

elderly population (6, 7). In addition to better life expectancy,

elderly people with relatively high HDL levels have been

reported to be healthier and more vigorous than those whose

HDL levels were consistently low [8]. Furthermore, severe

disability is strongly associated with low HDL-C levels in this

population group (9).By contrast, the relationship between HDL-C levels and

cognitive function remains controversial, although there is

increasing evidence that high HDL-C levels are associated with

improved cognition and dementia-free survival (10, 11). For

example, in a preliminary study with a small sample of

nonagenarians living in our area, we reported that one out of

four nonagenarians had low serum HDL-C concentrations, and

that higher levels of HDL-C correlated with better functional

status and the use of fewer chronic prescription drugs (12). In

this study subjects with low HDL-C scores had poor cognitive

functioning (measured by MEC scores), but this relationship

was not maintained in the multivariate analysis.The aim of the present study was to determine whether there

is an independent association between HDL-C and physical

function and to study a possible association with cognitive

performance in a broad sample of 85-year-old community-

dwelling subjects.

Methods

This study derives from the OCTABAIX project, a

prospective, population-based study of 328 community-

dwelling subjects born in 1924 (aged 85 at the time of

inclusion) and assigned to seven primary healthcare teams in

SERUM HIGH-DENSITY LIPOPROTEIN CHOLESTEROL LEVELS CORRELATE

WELL WITH FUNCTIONAL BUT NOT WITH COGNITIVE STATUS

IN 85-YEAR-OLD SUBJECTS

F. FORMIGA1, A. FERRER2, D. CHIVITE2, X. PINTO3, T. BADIA4, G. PADROS5, R. PUJOL1

1. Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain; 2. Primary Healthcare Centre ‘El Plà’ CAP-I, Sant

Feliu de Llobregat, Barcelona, Spain; 3. Lipid and Vascular Risk Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona,

Spain; 4. Centro de Atención Primaria ‘Martorell Urbà’, Martorell, Barcelona, Spain; 5. Laboratori Clínic Metropolitana Sud, Atenció Primària, L’Hospitalet de Llobregat, Barcelona,

Spain. Corresponding author: Francesc Formiga, MD, PhD, Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, 08907 L’Hospitalet de Llobregat, Barcelona,

Spain, E-mail: [email protected], Phone: (+34) 93 260 74 19; Fax: (+34) 93 260 74 20

Abstract: Objectives: We evaluate the association between high-density lipoprotein cholesterol (HDL-C) levels

and physical and cognitive performance indicators in 85-year-old subjects. Design: Prospective cohort study.

Setting: A community-based study. Participants: 321 subjects enrolled in the Octabaix Study. Methods:

Functional status was determined using the Lawton-Brody Index (LI) and the Barthel Index (BI). Cognition was

assessed using the modified Spanish version of the Mini-Mental State Examination (MEC). We also measured

risks related to nutrition and falls, as well as comorbidity and chronic drug prescription. HDL-C serum

concentrations <40 mg/dl for men and <46 mg/dl for women were used as cut-off values to discriminate between

normal and low HDL-C concentrations. Results: The sample consisted of 197 women (61%) and 124 men. Mean

HDL-C levels were 56.5 ± 15 mg/dl, with gender differences being found (59.3 ± 15 mg/dl in women vs. 52.1 ±

13 mg/dl in men; p<0.0001). Sixty-one subjects (19%) had low HDL-C values. HDL-C levels correlated with BI

(r=0.11, p=0.04) and LI (r=0.17, p=0.002) scores, but not with MEC scores (r=0.08, p=0.13). Poor BI and LI

scores, lower MEC scores, a risk of falls and malnutrition, and polypharmacy were all associated with lower

HDL-C values in the bivariate analysis. Multiple logistic regression analysis showed only a significant

association between normal HDL-C serum values and better BI scores (p<0.001, OR 1.02, 95% CI 1.01-1.04).

Conclusions: Individuals with higher levels of HDL-C had better functional and cognitive status, but after

multivariate analysis this relationship only remained significant for functional status.

Key words: High-density-lipoprotein cholesterol, oldest old, physical function, cognitive function.

449

The Journal of Nutrition, Health & Aging©

Volume 16, Number 5, 2012

Received May 31, 2011

Accepted for publication July 4, 2011



the geographical area of Baix Llobregat in Barcelona, Spain.

The participation rate was 67.5% and there were no differences

among respondents in terms of gender. The combined

population served includes approximately 210,000 inhabitants

and the referral hospital is the Hospital Universitari deBellvitge.

The sample has been described in more detail elsewhere (13,

14). Subjects were examined at their place of residence by

trained teams (medical doctors and nurses) skilled in

interviewing the elderly. An interview was performed in all

cases in which the individual was able to participate. A geriatric

assessment and socio-demographic data (gender, marital status,

place of residence, education, and living alone) were included

in the interview. Functional, cognitive and nutritional status

were assessed by instruments currently used in geriatric

practice. Gait and the number of falls were also assessed. The

study was approved by the institutional ethics committee and

all patients, or their caregivers in case of those who were

cognitively impaired, gave written informed consent before

enrolment. We assessed all patients and no exclusion criteria,

such as impaired health or cognitive status, were applied. The

present analysis refers to 321 participants, following the

exclusion of seven individuals because of missing values for

the study variables.

Global geriatric assessment

Functional status was measured using the Barthel Index (BI)

(15) for basic activities of daily living (ADL) and the Lawton

Index (16) (LI) for instrumental ADL. The total score of the BI

ranges from 0-100 points (from help needed in all activities tototal independence), while the LI score ranges from 0 (low

function, dependent) to 8 (high function, independent).

Cognitive function was measured by the modified Spanish

version of the Mini-Mental State Examination (MEC) (17): on

this scale the maximum score is 35, and scores of 23 or below

indicate cognitive impairment. The score was corrected by

education level

Nutritional status was assessed using the Mini Nutritional

Assessment (MNA). The MNA score is based on 18 items

covering four component sub-scores: MNA-1 (four items),

anthropometric measurement (0–8 points); MNA-2 (six items),

global evaluation (0–9 points); MNA-3 (six items), assessmentof dietary habits (0–9 points); and MNA-4 (two items),

subjective assessment of self-perceived quality of health and

nutrition (0–4 points) (18). The score obtained (maximum 30

points) allowed the elderly subjects to be classified into three

categories: 24–30, well-nourished; 17–23.5, at risk of

malnutrition; and <17, malnourished.

Gait was evaluated using a modified version of the Gait

Rating Scale from the Tinetti Performance-Oriented Mobility

Assessment. Gait consists of nine components: initiation of

gait, step height and length, step symmetry and continuity, path

deviation, trunk stability, walking stance, and turning while

walking (19). Each component was scored as either 1 (normal)

or 0 (abnormal), providing a final score which ranged from 0 to

9, with higher scores indicating a better gait performance.

Subjects with higher scores on the Tinetti have more risk of

falls A fall was defined as any incident in which the patient

ends up on the ground or at a lower level against his/her will(and not due to an intentional movement) (20). Patients and/or

caregivers were asked about any previous falls in the last year.

The Charlson Index was used to measure global comorbidity

(21). The score here ranges from 0 to a theoretical maximum of

33, depending on the presence of certain diseases with assigned

values. Disease prevalence was determined on the basis of a

review of data from general practice records for stroke and

ischemic cardiopathy. Chronic drug prescription was also

recorded using an extensive review of prescriptions according

to data from medical records and confirmed in personal

interview.

Succesful Aging

We defined non-disabled subjects as those with a better

health status (successful age), who, in addition to being non-

institutionalized (social criteria), had scores of 91 or higher on

the BI( subjects with total independency for basic ADL or

minimal dependence) and 24 or higher on the MEC (scores of

23 or below indicate cognitive impairment) (22).

Blood measurements

Blood was collected in tubes without anticoagulant after an

overnight fast (at least 12 h). Each specimen was centrifuged at

1200 × g for 10 min at room temperature and stored at 4°C until

analysis. Serum HDL-C concentrations were measured by adirect enzymatic colorimetric method (HDL-C Plus, Roche

Diagnostics, Basel, Switzerland) and were calculated using the

Friedewald equation (23). The inter-assay coefficient of

variation for HDL-C was less than 5.0%. Total cholesterol

(CHOD-PAP, Roche Diagnostics, Basel, Switzerland) and

LDL-C concentrations (GPO-PAP, Roche Diagnostics, Basel,

Switzerland) were also measured by an enzymatic colorimetric

method. All procedures were carried out with a modular system

analyser (Roche Diagnostics, Basel, Switzerland).

Procedure

In order to categorize HDL-C levels as either low or normalwe followed the European guidelines on CVD prevention in

clinical practice, which consider HDL-C serum concentrations

below 40 mg/dl (<1.0 mmol/l) for men and below 46 mg/dl

(<1.2 mmol/l) for women as being markers of increased

cardiovascular risk (24).

Statistical analysis

Data were analysed using SPSS 15.0 statistical software

(SPSS Inc., Chicago, III). P-values less than 0.05 were

considered significant. All data are expressed as means ±

standard deviations or frequencies (number, %), as required.

HDL-C was examined as a continuous variable for descriptive

HIGH-DENSITY LIPOPROTEIN CHOLESTEROL IN OCTOGENARIANS



450



and correlation analysis, and also as a categorical variable

(lower or higher according to the chosen cut-off). Normality of

variables was tested by the Kolmogorov-Smirnov test. The

Student’s T test was used to compare continuous variables,

with a prior Levene test for equality of variances, while eitherthe chi-square statistic or Fisher’s exact test was used for the

comparison of categorical or dichotomous variables.

Correlations between variables were calculated using the

Pearson or Spearman coefficient (r), as appropriate. The

variables associated with low HDL-C values were determined

by logistic regression analysis. The variables entered into the

multivariate model were BI, LI, MEC, MNA, Tinetti and the

number of chronically prescribed drugs (all continuous

variables, without categorization strategy), corrected by gender

and educational level.

Results

Three hundred and twenty-one individuals were finally

included, 197 women (61%) and 124 men. With regard to

marital status, 168 (52.3%) were widowed, 20 (6.2%) were

single and 133 (41.4%) were married. One hundred and ten

subjects (34.3%) were illiterate, 151 (47.7%) had attended

primary school, 46 (14.3%) high school, and 14 (4.4%) had a

university degree. Ninety-eight (30.5%) lived alone.

Geriatric assessment

Mean scores on the LI and BI were, respectively, 5.4 ± 2 and

87.7 ± 18. In 194 subjects (60%) the BI was >89. The mean

MEC score was 26.7 ± 6, and was 24 or higher in 233 subjects

(72.6%). Assessing function and cognition together, 159(49.5%) subjects met the criteria for successful ageing. HDL-C

serum concentrations were slightly higher in the successful

ageing group (57.1 vs. 55.8; p=0.44). Regarding comorbidity,

the mean Charlson Index was 1.4 ± 1.5. The mean number of

chronically prescribed drugs was 6.1 ± 3, with 254 subjects

(79.1%) receiving three or more drugs.

The mean score on the MNA, used to detect the risk of

malnutrition, was 24.5 ± 3. The assessment of gait yielded a

mean score on the Tinetti Gait Scale of 6.6 ± 2.8. The mean

number of falls during the previous year was 0.4 ± 0.9.

Lipid profile

For the whole study population, mean HDL-C levels were

56.5 ± 15 mg/dl, with gender differences being found (59.3 ±

15 mg/dl in women vs. 52.1 ± 13 mg/dl in men; p<0.0001).

Sixty-one subjects (19%) had HDL-C values below the cut-off

value for normality. HDL-C levels were correlated with scores

on the BI (r=0.11, p=0.04) and LI (r=0.17, p=0.002), but not

with MEC scores (r=0.08, p=0.13).

Mean LDL-C values were 114 ± 31 mg/dl, and in 80

(24.9%) subjects this value was equal to or higher than 135

mg/dl. Total serum cholesterol levels for the whole population

was 194 ± 36 mg/dl, and in 63 nonagenarians (19.6%) these

values were equal to or higher than 220 mg/dl.

Table 1 shows the differences between patient groups

according to the predefined cut-off values for HDL-C. Poor BI

and LI scores lower MEC scores, poor MNA scores, a higher

risk of falling, and more polypharmacy were all associated with

lower HDL values in the bivariate analysis. Multiple stepwise

logistic regression analysis (table 2) showed a significantassociation between normal baseline HDL-C serum values and

better ADL performance, as indicated by higher BI values

(p<0.001, OR 1.02, 95% CI 1.01-1.04).

Table 1

Differences between 85-year-old subjects according to serum

HDL-C levels. HDL-C serum concentrations below 40 mg/dl

for men and below 46 mg/dl for women were considered the

cut-off values to discriminate between low and normal HDL-C.

Values are expressed as the number (percentage) or mean

(standard deviation)

Low HDL Normal HDL P(n=61) (n=260)

GenderFemale 39 (63.9%) 158 (60.8%) 0.64Male 22 (36.1%) 102 (39.2%) Marital statusWidow 27 (44.3%) 141 (54.2%) 0.25Married 31 (50.8%) 102 (39.2%)Single 3 (4.9%) 17 (6.5%) Educational levelIlliterate 26 (42.6%) 84 (32.3%) 0.29Primary school 24 (39.3%) 127 (48.8%)High school 7 (11.5%) 39 (15%)Degree 4 (6.6%) 10 (3.8%)Barthel index 78.6 ± 28 89.8 ± 15 0.001Barthel index >90 28 (45.9%) 166 (63.8%) 0.01Spanish Mini-Mental State 24.2 ± 8 27.3 ± 6 0.001Spanish Mini-Mental State >23 41 (67.2%) 192 (73.8%) 0.29Successful ageing 24 (39.3%) 135 (51.9%) 0.07Lawton-Brody index 4.5 ± 2.8 5.6 ± 2.4 0.005Charlson Index 1.5 ± 1.4 1.4 ± 1.6 0.52Chronically prescribed drugs 6.8 ± 3.1 5.9 ± 3.2 0.04Nutritional assessment questionnaire 23.5 ± 3.9 24.7 ± 3.5 0.01Living alone 13 (21.3%) 85 (32.7%) 0.08Tinetti Gait Scale 5.6 ± 3.2 6.9 ± 2.7 0.002Falls previous year 0.4 ± 1.6 0.4 ± 0.7 0.86Stroke 12 (19.7%) 37 (14.2%) 0.28Ischemic cardiopathy 5 (8.2%) 15 (5.8%) 0.48Total cholesterol, mg/dl 174 ± 34 199.3 ± 35 0.001LDL cholesterol, mg/dl 105.1 ± 30 116.5 ± 31 0.01

Table 2

Multiple regression analysis model

P-value Odds ratio 95 % Confidence

Interval

Lawton Index 0.62 0.73 0.79-1.13

Spanish version of the 0.13 1.03 0.98-1.08

Mini-Mental State Examination

Nutritional assessment 0.93 1.04 0.91-1.15

questionnaire

Chronically prescribed drugs 0.24 0.86 0.83-1.01

Tinetti Gait Scale 0.83 1.01 0.74-1.21

Barthel Index 0.0001 1.02 1.01-1.04

JNHA: NUTRITION



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HIGH-DENSITY LIPOPROTEIN CHOLESTEROL IN OCTOGENARIANS

Discussion

There is no consensus regarding the lipid profile considered

characteristic of the very elderly population. Some studies have

reported that centenarians show a lipid profile similar to that of the middle-aged population, while others have demonstrated

lower total and HDL cholesterol levels at this extreme age (3).

In the Mediterranean region, where this study was conducted,

HDL-C values are expected to be higher than in other areas

(25). In a previous study conducted in our area in a group of

subjects nearly ten years older than those in the present study

(mean age 94 years old) (12), we found a higher proportion of

subjects with low HDL-C serum values (25.8%) than was the

case in the current sample (19%).

The mean HDL-C level was 56.5 ± 15 mg/dl, similar to the

value found in nonagenarians (60 mg/dl) but higher than that

reported in the ilSIRENTE study conducted in the Sirente

geographic area (Italy) (7). In this sample of Spanish

octagenarians the presence of gender differences in the HDL-C

means values was confirmed (59.3 in women vs. 52.1 mg/dl in

men).

The main finding of this study is that it confirms the

relationship between serum HDL-C values and functional status

(BI) that was previously reported in the NonaSantfeliu study

(12). These results are consistent with those previously reported

for subjects enrolled in the ilSIRENTE study (8), which found

that higher levels of HDL-C are associated not only with

functional status but also with better physical performance (4 m

walking speed and short physical performance battery scores).

Similarly, it has been reported that in non-disabled persons(mean age 73.7), HDL-C levels are highly correlated with knee

extension torque and walking speed (26). The mechanism

behind this association is unknown, although it has been argued

that low HDL-C levels, by increasing the risk of ischemic heart

disease, stroke and peripheral artery disease, could, in turn,

cause a decline in lower extremity performance and muscle

strength (27). However, Volpato et al. (26) argued that rather

than interpreting their results as suggesting a protective effect

of HDL-C on the atherosclerotic process, it was necessary to

explain the association between low HDL-C and functional

impairment. Moreover, in addition to the beneficial role of

regular exercise in terms of increased HDL, HDL-C has beenfound to confer additional metabolic properties that may

explain atheroprotection and could preserve quality of life and

promote longevity (26). Currently, one of the main lines of

research aimed at a better understanding of the association

between HDL-C and functional status is focused on the

possible role of inflammation. Thus, Cesari et al. (28) recently

suggested that in the presence of low HDL-C levels there is a

strong association between inflammatory biomarkers and

physical function.

In addition to the association with the BI, the bivariate

analysis also revealed interesting associations that were not

confirmed in the multivariate analysis. Specifically, subjects

with lower HDL-C values had poor LI scores (another test of

function), lower MEC scores, poor MNA scores and poor gait

performance (Tinetti), and were also taking more chronically

prescribed drugs. The LI and Tinetti Gait Scale associations are

probably related to the association between HDL-C values andphysical function. However, the relationship between HDL-C

and cognitive status merits more detailed discussion because

there is no consensus on this topic. Indeed, the role of HDL-C

in the risk for and progression of cognitive impairment remains

unclear, not to say controversial (29). Few studies have

evaluated the association between dementia and specific

lipoprotein fractions, although some authors have reported that

low HDL-C is correlated with cognitive impairment and

dementia, suggesting that part of this association might be

independent of atherosclerotic disease (30, 31). In the present

study we found that 85-year-old subjects with low HDL-C

scores had worse cognitive functioning (in terms of MEC

values), although this relationship was not maintained in the

multivariate analysis. A similar result was previously reported

in nonagenarians in our area (12).

The MNA has been extensively used to identify the risk of

malnutrition in the elderly. A previous Octabaix evaluation

showed that lower MNA scores correlated with a greater

likelihood of having lower vitamin D serum values (14), as is

the case with lower HDL-C serum values in the present study.

Finally, the bivariate analysis showed significantly more

polypharmacy and a tendency toward higher scores on the

Charlson Index in the low HDL-C subgroup.

One of the main strengths of the present study is the

population-based design: our unselected sample isrepresentative of the population aged 85 years in a mostly

Caucasian community. Moreover, the geriatric tools used in the

study are all validated and commonly used. On the other hand,

the main limitation of this study is that lipid levels were

measured only once, which could have led to measurement

error and an underestimation of the association between HDL-

C levels and the factors evaluated. It should also be borne in

mind that the use of HDL-C values suggested by the European

Society of Cardiology (which are good for identifying adult

subjects with increased risk) may not be useful to define low

HDL-C in a sample of Spanish 85-year-old subjects.

Furthermore, we did not adjust for confounders such as use of lipid-lowering drugs, smoking habits, alcohol use and physical

exercise, all of which can strongly impact on HDL-C levels.

Finally, the cross-sectional design does not enable a causal

relationship to be established between scores on the measures

of functional status and HDL-C levels.

Conclusions

This study demonstrates that among 85-year-old persons

living in the community, high levels of HDL-C are

independently associated with a better functional status.



Acknowledgments: Members of the Octabaix Study: J Almeda (Unitat de Suport a la

Recerca de Costa de Ponent, IDIAP J Gol), T Badia (ABS Martorell Urbano), C Llopart

(ABS Sant Andreu de la Barca), C Fernández (CAP Rambla), A Ferrer (CAP El Pla), F

Formiga (UFISS de Geriatría. Servicio de Medicina Interna, Hospital Universitari de

Bellvitge), A Gil (ABS Sant Andreu de la Barca), MJ Megido (ABS Just Oliveras), G

Padrós (Laboratori Clínic L’Hospitalet-Cornellà), M Sarró (CAP Florida Nord), A Tobella

(ABS Martorell Rural).

Financial disclosure: We declare that we have no conflict of interest;

This study was supported by public funding from the Fondo de Investigación Sanitaria-

Instituto de Salud Carlos III, Spain (Number PS09/00552).

References

1. Oeppen J, Vaupel JW. Demography. Broken limits to life expectancy. Science 2002;

296: 1029–31.

2. Hayashi T, Iguchi A. Possibility of the regression of atherosclerosis through the

prevention of endothelial senescence by the regulation of nitric oxide and free radical

scavengers. Geriatr Gerontol Int. 2010; 10: 115-30.

3. Arai Y, Hirose N. Aging and HDL metabolism in elderly people more than 100 years

old. J Atheroscler Thromb. 2004; 11:246-52.

4. de Freitas EV, Brandão AA, Pozzan R, Magalhães ME, Fonseca F, Pizzi O, et al.

Importance of high-density lipoprotein-cholesterol (HDL-C) levels to the incidence

of cardiovascular disease (CVD) in the elderly. Arch Gerontol Geriatr. 2011; 52:217-

22.

5. Weverling-Rijnsburger AW, Jonkers IJ, van Exel E, Gussekloo J, Westendorp RG.

High-density vs low-density lipoprotein cholesterol as the risk factor for coronary

artery disease and stroke in old age. Arch Intern Med. 2003; 163:1549-54.

6. Volpato S, Leveille SG, Corti MC, Harris TB, Guralnik JM. The value of serum

albumin and high-density lipoprotein cholesterol in defining mortality risk in older

persons with low serum cholesterol. J Am Geriatr Soc. 2001; 49:1142-7.

7. Landi F, Russo A, Pahor M, Capoluongo E, Liperoti R, Cesari M, et al. Serum high-

density lipoprotein cholesterol levels and mortality in frail, community-living elderly.

Gerontology. 2008; 54:71-8.

8. Landi F, Russo A, Cesari M, Pahor M, Bernabei R, Onder G. HDL-cholesterol and

physical performance: results from the ageing and longevity study in the sirente

geographic area (ilSIRENTE Study). Age Ageing. 2007; 36:514-20.

9. Zuliani G, Romagnoni F, Bollini C, Leoci V, Soattin L, Fellin R. Low levels of high-

density lipoprotein cholesterol are a marker of disability in the elderly. Gerontology.1999; 45:317-22.

10. Kontush A, Chapman MJ. HDL: Close to our memories? Arterioscler Thromb Vasc

Biol 2008;28:1418-20.

11. Reitz C, Tang MX, Schupf N, Manly JJ, Mayeux R, Luchsinger JA. Association of

higher levels of high-density lipoprotein cholesterol in elderly individuals and lower

risk of late-onset Alzheimer disease. Arch Neurol. 2010; 67:1491-7.

12. Formiga F, Ferrer A, Chivite D, Pinto X, Cuerpo S, Pujol R. Serum high-density

lipoprotein cholesterol levels, their relationship with baseline functional and

cognitive status, and their utility in predicting mortality in nonagenarians. Geriatr

Gerontol Int 2011; 11: 358–364.

13. Ferrer A, Badia T, Formiga F, Gil A, Padrós G, Sarró M, Almeda J, Pujol R; Grupo

de Estudio OCTABAIX. Ensayo aleatorizado de prevención de caídas y malnutrición

en personas de 85 años en la comunidad. Estudio OCTABAIX. Rev Esp Geriatr

Gerontol 2010; 45: 79-85.

14. Formiga F, Ferrer A, Almeda J, San Jose A, Gil A, Pujol R Utility of geriatric

assessment tools to identify 85-years olds subjects with vitamin D deficiency. J Nutr

Health Aging 2011; 15: 110-4.

15. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. A simple index

of independence useful in scoring improvement in the rehabilitation of the

chronically ill. Md State Med J 1965; 14: 61-5.

16. Lawton MP, Brody EM. Assessment of older people: self-maintaining and

instrumental activities of daily living. Gerontologist 1969; 9:179-86.

17. Lobo A, Saz P, Marcos G, Día JL, De la Cámara C, Ventura T, et al. Revalidación ynormalización del Mini-Examen Cognoscitivo (primera versión en castellano del

Mini-mental Status Examination) en la población general geriátrica. Med Clin (Barc)

1999; 112: 767-74.

18. Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly: the Mini

Nutritional Assessment as part of the geriatric evaluation. Nutr Rev. 1996; 54(1 Pt

2):S59-65.

19. Tinetti ME. Performance-oriented assessment of mobility problems in elderly

patients. J Am Geriatr Soc 1986; 34; 119-26.

20. Buchner DM, Hornbrook MC, Kutner NG, Tinetti ME, Ory MG, Mulrow CD, et al.

Development of the Common Data Base for the FICSIT Trials. J Am Geriatr Soc

1993; 41; 297-308.

21. Charlson ME, Pompei P, Ales KL, Mackenzie CRl. A new method of classifying

prognostic comorbidity in longitudinal studies: Development and validation J

Chronic Dis 1987; 40:373-83.

22. Formiga F. Ferrer A, Megido MJ, Chivite D, Badia T, Pujol R. Low comorbidity,

low levels of malnutrition and low risk of falls in a community-dwelling sample of

85 year-olds are associated with successful aging. The Octabaix study. Rejuvenation

Research 2011; Rejuvenation Res. 2011; 14: 309-1423. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-

density lipoprotein cholesterol in plasma, without use of the preparative

ultracentrifuge. Clin Chem 1972;18:499–502

24. Fourth Joint Task Force of the European Society of Cardiology and Other Societies

on Cardiovascular Disease Prevention in Clinical Practice (Constituted by

representatives of nine societies and by invited experts). European guidelines on

cardiovascular disease prevention in clinical practice: executive summary. Eur Heart

J 2007; 28: 2375–414.

25. Cea-Calvo L, Lozano JV, Fernández-Pérez C, Llisterri JL, Martí-Canales JC, Aznar

J, et al; Investigators of PREV-ICTUS study. Prevalence of low HDL cholesterol,

and relationship between serum HDL and cardiovascular disease in elderly Spanish

population: the PREV-ICTUS study. Int J Clin Pract. 2009; 63:71-81.

26. Volpato S, Ble A, Metter EJ, Lauretani F, Bandinelli S, Zuliani G,et al. High-density

lipoprotein cholesterol and objective measures of lower extremity performance in

older nondisabled persons: the InChianti study. J Am Geriatr Soc. 2008; 56: 621-9.

27. Newman AB, Arnold AM, Naydeck BL, Fried LP, Burke GL, Enright P, Gottdiener

J, Hirsch C, O'Leary D, Tracy R; Cardiovascular Health Study Research Group.Successful aging: Effect of sub-clinical cardiovascular disease. Arch Intern Med.

2003; 163:2315–22.

28. Cesari M, Marzetti E, Laudisio A, Antonica L, Pahor M, Bernabei R, Zuccalà G.

Interaction of HDL cholesterol concentrations on the relationship between physical

function and inflammation in community-dwelling older persons. Age Ageing. 2010;

39: 74-80.

29. Wieringa GE, Burlinson S, Rafferty JA, Gowland E, Burns A. Apolipoprotein E

genotypes and serum lipid levels in Alzheimer’s disease and multi-infarct dementia.

Int J Geriatr Psychiatry. 1997;12:359–62

30. van Exel E, de Craen AJ, Gussekloo J, Houx P, Bootsma-van der Wiel A, Macfarlane

PW, et al. Association between high-density lipoprotein and cognitive impairment in

the oldest old. Ann Neurol. 2002; 51:716-21.

31. Zuliani G, Cavalieri M, Galvani M, Volpato S, Cherubini A, Bandinelli S, et al.

Relationship between low levels of high-density lipoprotein cholesterol and dementia

in the elderly. The InChianti study. J Gerontol A Biol Sci Med Sci. 2010; 65: 559-

64.

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