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Q J Med 2001; 94: 457-463
© 2001 Association of Physicians

Review

Cholesterol lowering in the older population: time for reassessment?

N. Kagansky1, S. Levy1, Y. Berner1, E. Rimon1 and H. Knobler2,

1 From the Department of Geriatrics and 2 Metabolic Service, Kaplan Medical Centre, Rehovot, and The Hebrew University Hadassah Medical School of Medicine, Jerusalem, Israel

Hypercholesterolaemia is an established major risk factor for coronary heart disease (CHD) in the general population. In the vast majority of studies that focused on this particular age group and carefully eliminated other confounding factors such as co-morbid conditions, hypercholesterolaemia was a risk factor for CHD in the older population. Because the prevalence of CHD increases with advancing age, studies that consider not only the relative risk attributed to cholesterol but also the absolute numbers of people affected, show hypercholesterolaemia to be an even stronger risk factor in the elderly. Large primary and secondary prevention studies of HMG-CoA reductase inhibitors (statins) in the elderly have shown a reduction in major coronary events similar to that observed in the younger age group. The role of hypercholesterolaemia as a risk factor for stroke is less clear, and a major limitation is the heterogeneous nature of the disease. Nevertheless, most studies that evaluated non-haemorrhagic strokes separately showed a positive association with cholesterol levels, and statin therapy is effective in preventing stroke. These data provide a rationale for treating older hypercholesterolaemic people with statins, not only to prevent CHD, but also to prevent stroke.

Address correspondence to Dr H. Knobler, Metabolic Service, Kaplan Medical Centre, Rehovot, Israel


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