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Secondary prevention and referral of elderly patients to a cardiovascular lipid service
1Department of Molecular Pathology and Clinical Biochemistry, Royal Free and University College Medical School (University of London), Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK.
Insights
Cardiovascular disease in the elderly highlights the importance of lipid profiles for secondary prevention. Management benefits are evident, though recognition and treatment of secondary lipemia and obesity require improvement in older adults.
Area of Science:
- Gerontology
- Cardiology
- Clinical Lipidology
Background:
- Cardiovascular disease (CVD) burden in the elderly increases interest in lipid profiles.
- Lipid management offers benefits, particularly in secondary prevention for older adults.
- Understanding lipid profiles in elderly patients is crucial for effective CVD management.
Purpose of the Study:
- To analyze the clinical and laboratory characteristics of elderly patients referred to a specialist cardiovascular lipid service.
- To assess the prevalence of dyslipidemia and associated vascular disease in this demographic.
- To evaluate the effectiveness of current referral and management practices for lipid disorders in the elderly.
Main Methods:
- Retrospective analysis of 210 consecutive referrals (90 males, 120 females) aged over 70 years to a specialist cardiovascular lipid service.
- Review of referral sources, presenting lipid profiles (cholesterol, triglycerides, HDL), and identification of secondary lipemia.
- Assessment of co-existing vascular disease and other risk factors, including lipoprotein(a) levels.
Main Results:
- Referrals originated mainly from vascular surgery (47%), general practice (41%), and cardiology (9%).
- Elevated lipid levels were observed, with higher cholesterol in females and higher HDL in females, suggesting greater awareness in males but significant disease in females.
- Secondary lipemia was prevalent (62.3%), and significant vascular disease was identified in 166/210 patients.
- Elevated lipoprotein(a) levels were noted in patients with vascular disease.
- Referral justification was confirmed in most accepted cases, with limited burden from routine health checks.
Conclusions:
- Specialist lipid services effectively identify and manage atheroma-related disease in elderly referrals.
- Incomplete recognition and management of secondary lipemia and obesity persist.
- Targeted referrals to specialist lipid services are justified for secondary prevention in the elderly population.
Abstract:
The burden of cardiovascular disease in the elderly has increased interest in lipid profiles which retain associations with outcome except at extreme age and for which management has benefits at least in secondary prevention. The source, clinical and laboratory background of 90 male and 120 female consecutive referrals age >70 years to a specialist cardiovascular lipid service have been analysed. Main sources were vascular surgery 47%, cardiology 9% and general practice 41% with 6% referred through routine health checks. Presenting lipids (mM: mean+/-S.D.) were: males: cholesterol 6.9+/-1.7, triglycerides 2.3+/-1.5, HDL 1.2+/-0.3; females: cholesterol 7.8+/-1.4, triglycerides 2.1+/-1.3, HDL 1.5+/-0.5, consistent with greater awareness of lipid-related problems in males but significant vascular disease in females. Secondary lipemia was defined in 131/210, 62.3% of patients (83 recognised before clinic presentation, 48 found at follow-up, mainly diabetes). Significant vascular disease was identified in 166/210 patients, significant other risk factors in another 35 patients. Levels of lipoprotein(a) were widely distributed for all groups, but elevated against population profiles for all groups with vascular disease. Referrals were monitored and not routinely accepted: reassuringly most then accepted were justified through atheroma-related disease and opportunities for secondary prevention, with little additional burden through untargeted routine health checks. Recognition of and management of secondary lipemia and obesity were however incomplete.
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