Hypertension and dyslipidemia are highly prevalent in the elderly. We studied the combined impact of both conditions on cardiovascular disease (CVD) events.

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.

• 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 ≥160/100 mm Hg and LDL-C ≥160 mg/dl,
• and from 28.9 when BP <120/80 mm Hg and HDL >60 mg/dl to 87.1 for a BP ≥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 ≥160/100 mm Hg and LDL-C ≥160 mg/dl and 2.1 when BP ≥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.

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 dyslipidemia.

Nathan D. Wong¹, Victor A. Lopez¹, Craig S. Roberts², Henry A. Solomon², Gregory L. Burke³, Lewis Kuller⁴, Russell Tracy⁵, David Yanez^6,7,8,9 and Bruce M. Psaty^6,7,8,9

1. ^{1Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California, Irvine, California, USA 2Pfizer Inc., New York, New York, USA}
2. ^{3Wake Forest University, Wake Forest, North Carolina, USA}
3. ^{4University of Pittsburgh, Pittsburgh, Pennsylvania, USA}
4. ^{5University of Vermont, Burlington, Vermont, USA}
5. ^{6Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA}
6. ^{7Department of Epidemiology, University of Washington, Seattle, Washington, USA 8Department of Health Services, University of Washington, Seattle, Washington, USA 9Center for Health Studies, Group Health, Seattle, Washington, USA}

Correspondence: Nathan D. Wong, ndwong@uci.edu