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Lipid metabolism and cardiovascular risk: should hypercholesterolemia be treated in the elderly?
1Chair of Geriatrics, University of Bari Medical School, Italy.
Insights
Elevated serum cholesterol may pose risks for elderly individuals, but moderate reduction might improve quality of life and reduce coronary heart disease incidence. Further trials are needed to confirm these findings in older adults.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Public Health
Background:
- The significance of elevated serum cholesterol as a risk factor for coronary heart disease (CHD) in the elderly compared to middle-aged individuals remains unclear.
- Observational studies present conflicting data: Framingham indicated an association only in elderly women, while the Honolulu Heart Program found it in men over 65.
Purpose of the Study:
- To review the current understanding of serum cholesterol's role in CHD risk among the elderly.
- To highlight concerns regarding cholesterol reduction in older populations based on existing evidence.
Main Methods:
- Review of observational studies (Framingham, Honolulu Heart Program) examining cholesterol-CHD associations in older adults.
- Analysis of intervention studies (Lipid Research Clinics, Helsinki Heart Study) on cholesterol-lowering drugs.
- Examination of data on survival rates and cancer mortality in relation to cholesterol levels in the elderly.
Main Results:
- Intervention studies showed significant reductions in CHD morbidity and mortality but not total mortality.
- Concerns arise from reports of longer survival in elderly patients with moderate hypercholesterolemia and increased cancer mortality in hypocholesterolemic subjects.
- Some studies noted an increase in violent deaths following cholesterol reduction interventions.
Conclusions:
- Moderate reduction of elevated serum cholesterol in at-risk elderly patients may decrease CHD incidence and enhance quality of life.
- Further evaluation is required for the longer survival observed in moderately hypercholesterolemic elderly individuals and the increased cancer/violent death rates.
- Randomized controlled trials are necessary to validate the benefits and risks of cholesterol reduction in the elderly population.
Purpose:
It is not clear whether an elevated serum cholesterol level is as important a risk factor for coronary heart disease in the elderly as it is in middle-aged men. This review highlights some aspects of this issue.
Observational Studies:
The Framingham study showed that after the age of 65 years, serum cholesterol levels are associated with coronary heart disease only in women. The Honolulu (Hawaii) Heart Program, however, found that the same association also occurred in men aged over 65 years.
Intervention Studies:
The Lipid Research Clinics trial and the Helsinki Heart Study both aimed to reduce coronary heart disease mortality by a drug-induced reduction in serum cholesterol levels. Each produced a significant reduction in coronary morbidity and mortality, of 20 and 30%, respectively, but failed to reduce total mortality significantly. Moreover, an increase in violent death (accident or suicide) was reported by the Helsinki study.
Length Of Survival And Cancer Mortality:
Elderly patients with moderate hypercholesterolemia have been reported to survive longer than those with a lower cholesterol level. Further, a significant increase in the cancer mortality rate has been observed in hypocholesterolemic subjects. These data have aroused concern about reducing serum cholesterol levels in patients aged over 65 years.
Conclusions:
At present, it seems that a moderate reduction of elevated serum cholesterol levels in elderly patients at risk of coronary heart disease may reduce the incidence of this disease and improve the quality of life in the elderly. The proposal needs to be tested by a randomly allocated controlled trial. The longer survival of patients with moderate hypercholesterolemia and the increase in cancer mortality or violent death seen among hypercholesterolemic subjects need to be further evaluated.