Treatment of cholesterol in the elderly: statins and beyond

Lowering of low-density lipoprotein cholesterol levels is a worthwhile intervention in older (more than 65-70 years of age) subjects, since age itself is a powerful predictor of vascular disease risk. Although studies have not consistently demonstrated an overall beneficial effect on total mortality, cardiovascular morbidity and mortality are favorably affected. The drugs most extensively studied are statins, but similar results are at least suggested for other agents. The efficacy, safety, and benefits of statins make them the drugs of choice. Statin intolerance can be managed and should not lead immediately to an abandonment of therapy. In cases in which it cannot be overcome, other lipid-lowering drugs, either singly or in combination, can be used, although their side effects are generally more problematic and their benefits are less prominent. In older patients, prevention of disability from stroke, heart disease, or peripheral vascular diseases may be as important a goal as an overall beneficial effect on mortality, which, in the long run, is unavoidable.