Managing hyperlipidaemia in the elderly: special considerations for a population at high risk

Numerous randomised, double-blind, placebo-controlled studies and observational studies have shown that HMG-CoA reductase inhibitors (statins) reduce mortality and major cardiovascular events in elderly high-risk persons with hypercholesterolaemia. The Heart Protection Study showed that statins reduced mortality and major cardiovascular events in elderly high-risk patients regardless of the initial level of serum lipids, age or sex. The updated National Cholesterol Education Program III guidelines state that in very high-risk individuals, a target serum low-density lipoprotein cholesterol (LDL-C) level of <70 mg/dL (1.8 mmol/L) is a reasonable clinical strategy. When a high-risk patient has hypertriglyceridaemia or low high-density lipoprotein-cholesterol, consideration can be given to combining a fibric acid derivative or nicotinic acid with an LDL-C-lowering drug. For moderately high-risk patients (two or more risk factors and a 10-year risk for coronary artery disease of 10-20%), the serum LDL-C should be reduced to <100 mg/dL (2.6 mmol/L). When LDL-C-lowering drug therapy is used to treat high-risk patients or moderately high-risk patients, the serum LDL-C should be reduced by at least 30-40%.