As people age, the possibility of serious ailments increases substantially. Worries of diabetes mellitus, hypertension, cancer, osteoporosis and stroke seem much more important than fretting about high cholesterol. After 60 years of eating the wrong types of food, what difference would it make to change? But Dr. Margo Denke, assistant professor of internal medicine in the Center for Human Nutrition, says there is a definite benefit to cholesterol-lowering in the elderly if patients are carefully selected.
"The physician must ask, 'Is this patient relatively healthy? Does he or she have an active lifestyle? Does he or she have a good prognosis for an extended lifetime?'" she said. "In people older than 60, the risk of therapy maybe a little bit higher so the benefits must be clear. We do question, however, whether it's beneficial after age 80. "To reach her conclusion, Dr. Denke reviewed current research and published her findings in the may 15 issue of the Annals of Internal Medicine. Dr. Scott M. Grundy, director of the Center for Human Nutrition, co-authored the report.
Although no human trials have been carried out extensively in people over age 60 to determine if diet modifications or drug therapy lower their rates of coronary heart disease, Dr. Denke extrapolated results from previous clinical trials involving middle-aged men to draw her conclusions about the elderly. The Adult Treatment panel report of the National Cholesterol Education Program, a project designed to educate physicians and the public about the risks of high cholesterol, defines a high blood cholesterol level as greater than 240. Based on this criterion, one-third of older men and one-half of older women have high blood cholesterol levels. An even better predictor of coronary heart disease is the level of low-density lipoproteins or LDL, the "bad" cholesterol. An LDL of more than 160 is considered high risk and requires active management.
"Because the prevalence of elevated LDL-cholesterol levels in elderly persons is so high the overriding issue becomes whom to treat," Dr. Denke stated in the review. "If an older patient is otherwise in good health, the benefits from cholesterol-lowering therapy may well be worth the cost and risk of therapy. Clinical trial data suggest that a 1 percent lowering of cholesterol levels will produce a 2 percent decrease in coronary risk."
For other patients suffering from congestive hart failure, stroke, cancer, chronic lung disease, dementia or debilitating arthritis, an expensive and aggressive regimen to lower cholesterol would be of little benefit, Dr. Denke said.
