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Age-associated alterations in cholesterol homeostasis: evidence from a cross-sectional study in a Northern Italy population

Authors Bertolotti M, Mussi C, Pellegrini E, Magni A, Del Puppo M, Ognibene S, Carulli L, Anzivino C, Baldelli E, Loria P, Carulli N

Received 16 November 2013

Accepted for publication 23 December 2013

Published 17 March 2014 Volume 2014:9 Pages 425—432

DOI https://doi.org/10.2147/CIA.S57714

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Marco Bertolotti,1 Chiara Mussi,1 Elisa Pellegrini,1 Alessandro Magni,2 Marina Del Puppo,2 Silvia Ognibene,1 Lucia Carulli,1 Claudia Anzivino,1 Enrica Baldelli,1 Paola Loria,1 Nicola Carulli1

1Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; 2Department of Health Sciences, University of Milano Bicocca, Monza, Italy

Background: The modifications of cholesterol metabolism associated with aging are ill-defined. The objective of this study was to define age-associated alterations of the different metabolic pathways controlling cholesterol homeostasis by analyzing circulating sterols.
Methods: We analyzed serum samples collected from 201 adult (75 male, 126 female) subjects within the epidemiological MICOL study (Multicentrica Italiana Colelitiasi). The age range was 38–79 years; 103 had evidence of gallstones. The concentrations of the different sterols, recognized as markers of the main pathways of cholesterol homeostasis, were analyzed by gas chromatography–mass spectrometry, including lathosterol (synthesis), campesterol and sitosterol (absorption), and 7α-hydroxy-4-cholesten-3-one (degradation to bile acids).
Results: A significant direct correlation was detected between age and cholesterol levels (r=0.34, P<0.01). The lathosterol/cholesterol ratio was lower in older age quartiles (P<0.05 by analysis of variance), with an inverse correlation between the lathosterol/cholesterol ratio and age (r=−0.32, P<0.01). Such correlation was particularly evident in females. The campesterol/cholesterol and sitosterol/cholesterol ratios were inversely correlated with aging in control, but not in gallstone patients. The levels of 7α-hydroxy-4-cholesten-3-one were not correlated with age.
Conclusion: These data show a reduction of cholesterol synthesis with aging which is associated with increased circulating cholesterol levels. The finding might be related to a reduced metabolic need for cholesterol in advancing age, leading to a downregulation of the main mechanisms of cholesterol intake in the liver. A different age-related behavior was observed in gallstone-free versus gallstone patients regarding cholesterol absorption. The possible implications in terms of the pharmacological management of hypercholesterolemia in the elderly remain to be defined.

Keywords: aging, cholesterol metabolism, cholesterol synthesis, gallstone disease, cardiovascular risk

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