Lipoprotein alterations and atherosclerosis in the elderly

Lipoproteins play a key role in the pathogenesis of atherosclerotic diseases. With increasing age, modifications in the metabolism, distribution and correlates of lipoprotein lipids have been described. Age associated changes in lipoproteins are determined by several genetic and environmental factors, but in elderly populations, an important role is also played by the presence of comorbid diseases and poor health. In older populations, the ability of lipoprotein levels to predict cardiovascular risk is controversial. When lipoprotein levels are measured at old age, secondary changes in total and high density lipoprotein-cholesterol levels may lead to misclassification and to underestimation of associations. When analyzing associations in older populations, it is therefore important to consider measures of disease burden and comorbidity. When these caveats are taken into account, evidence from observational studies in older persons confirms the association between lipoprotein lipids, cardiovascular and cerebrovascular disease. Among older patients with cardiovascular disease, intervention trials have demonstrated that lipid lowering drugs can significantly reduce total and coronary heart disease mortality. Unequivocal evidence that lipid-lowering drugs are beneficial in old and very old persons without pre-existing cardiovascular disease is still lacking. Results from primary and secondary intervention trials in older men and women are needed to provide conclusive guidelines.