[Hypercholesterolemia, cardiovascular risk, and hypocholesteremic treatment in the elderly]

The role of cholesterol as a cardiovascular risk factor in the elderly is not completely clear at the moment. Epidemiologic studies show a continuous relation between cholesterol levels and cardiovascular risk even in the elderly, in fact, in spite of a lower Relative Risk, they have a greater Absolute Risk and Absolute Benefit Increase. In patients over 75-80 years old cholesterol loses its role as a risk factor, probably because of comorbidity, typical in this period. Trials show the efficacy of hypocholesterolemic therapy with statins in secondary prevention in the elderly; fewer data are available for primary prevention. Therapeutic attitudes suggest a pharmacologic intervention of secondary prevention in young and old elderly to lower LDL-C levels, which are more closely related to the events. In primary prevention we should use drugs to reach a LDL-C level lower for each additional risk factor, until 75 years old; in the old elderly we should decide on drug therapy according to the biological age and expected lifespan. Statins seem to be the most effective and safest drugs to reach this aim.