Cholesterol Lowering in the Elderly Population

Grundy, Scott M.; Cleeman, James I.; Rifkind, Basil M.; Kuller, Lewis H.

doi:10.1001/archinte.159.15.1670

Cited by 100 publications

(28 citation statements)

References 61 publications

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“…Elderly patients face a higher risk of recurrent MI and death than younger patients. 7 Although some question has arisen regarding the association between elevated cholesterol and cardiovascular risk in the elderly, individual clinical trials and meta-analysis have supported that patients age Ն65 years with established CAD derive substantial benefit from lipid-lowering medications. 7 Young women were less likely to be treated with lipid-lowering medications than young men, but after adjustment of other variables, sex of the patient was only a minor independent predictor of not receiving lipid treatment.…”

Section: Discussionmentioning

confidence: 99%

Use of Lipid-Lowering Medications at Discharge in Patients With Acute Myocardial Infarction

et al. 2001

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Background-The present study aimed to assess use of lipid-lowering medication at discharge in a current national sample of patients hospitalized with acute myocardial infarction and to evaluate factors associated with prescribing patterns. Methods and Results-Demographic, procedural, and discharge medication data were collected from 138 001 patients with acute myocardial infarction discharged from 1470 US hospitals participating in the National Registry of Myocardial Infarction 3 from July 1998 to June 1999. Lipid-lowering medications were part of the discharge regimen in 31.7%. Among patients with prior history of CAD, revascularization, or diabetes, less than one half of the patients were discharged on treatment.

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Section: Discussionmentioning

confidence: 99%

Use of Lipid-Lowering Medications at Discharge in Patients With Acute Myocardial Infarction

et al. 2001

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“…However, in all large statin studies, 4S [20], CARE [21] and LIPID [22], the results were equally good in individuals under and over 65 years of age. Thus, lipid lowering should also bene®t at least part of the``older [23]. Use of both beta-blockers and aspirin may have been reduced because of other conditions (obstructive lung disease, peripheral artery disease, bleeding risks).…”

Section: Discussionmentioning

confidence: 99%

Use of cardiovascular drugs by home-dwelling coronary patients aged 75 years and older

Strandberg

Pitkälä

Kulp

et al. 2001

European Journal of Clinical Pharmacology

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“…For instance, in older persons, epidemiological studies fail to show that the relative risk accompanying higher cholesterol levels is much greater than that for lower levels. 19 In contrast, clinical trials demonstrate that cholesterol-lowering therapy in older persons markedly reduces risk for future CHD events. 20 Thus, it cannot be assumed a priori that therapeutic modification of a risk factor will reverse risk for coronary events, as might be predicted from prospective studies.…”

Section: Chd Risk Factors: Predictor Versus Target Of Therapymentioning

confidence: 99%

Low-Density Lipoprotein, Non-High-Density Lipoprotein, and Apolipoprotein B as Targets of Lipid-Lowering Therapy

2002

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A lthough low-density lipoprotein (LDL) is widely recognized as the major atherogenic lipoprotein and the primary target of lipid-lowering therapy, 1 other lipoprotein species nonetheless appear to be involved in atherogenesis. These include very low-density lipoproteins (VLDL), intermediate-density lipoproteins (IDL), and highdensity lipoproteins (HDL). Both VLDL and IDL are triglyceride-rich lipoproteins (TGRLP). Thus, in the aftermath of unequivocal evidence that LDL lowering reduces risk for major coronary events and stroke, 2 the field of lipid study is turning more of its attention to the other lipoproteins that appear to be involved in atherosclerosis. The recent Adult Treatment Panel III (ATP III) report 1 of the National Cholesterol Education Program has summarized our current understanding of the relationship between other lipoprotein species and risk for coronary heart disease (CHD). See p 2537ATP III 1 placed more emphasis on TGRLP and HDL as secondary targets of lipid-modifying therapy than did previous ATP reports. 3 There is an emerging consensus that among TGRLP, cholesterol-rich remnant lipoproteins carry atherogenic potential. This view led ATP III to designate LDLϩIDLϩVLDL cholesterol (called non-HDL cholesterol) as "atherogenic cholesterol" and to identify it as a secondary target of therapy, after LDL cholesterol. In the ATP III report, however, non-HDL cholesterol as a secondary target is limited to persons who have elevated serum triglyceride levels (Ն200 mg/dL). In the majority of people who have lower triglyceride levels, LDL cholesterol contains the bulk of "atherogenic cholesterol" and thus is a sufficient target alone.The designation of elevated non-HDL cholesterol as a treatment target depended strongly on increasing data showing that high levels of cholesterol-rich TGRLP raise risk for CHD. Several reviews summarize the evidence for atherogenicity of triglyceride-rich remnants. 4 -6 On the other hand, only a limited number of studies 7,8 have examined the strength of association between non-HDL cholesterol and risk for CHD. The current report of Bittner et al 9 contributes to a growing body of information on the predictive power for major coronary events of non-HDL cholesterol. In the discussion to follow, the current status of non-HDL cholesterol as predictor of major coronary events and as a target of lipid-lowering therapy will be examined. Predictive Power of LipoproteinsEpidemiological studies reveal a strong independent relation between serum cholesterol levels and risk for CHD. 10 Since LDL is the major cholesterol-carrying lipoprotein of serum, it too is widely accepted as an independent risk factor. 1 Prospective surveys 11 further document that reduced serum levels of HDL cholesterol independently predict CHD incidence. The case for high serum triglycerides as a marker for TGRLP has been less robust. 11 Since HDL cholesterol and triglycerides are inversely correlated, when HDL is entered into multivariate predictive models, triglycerides are generally found to be weak pr...

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Cholesterol Lowering in the Elderly Population

Abstract: The incidence of coronary heart disease (CHD) peaks in the elderly population. In secondary and primary prevention trials, cholesterol-lowering therapy reduces risk for CHD in both older and younger participants. This benefit, therefore, can be extended to the elderly.

Cited by 100 publications

References 61 publications

Use of Lipid-Lowering Medications at Discharge in Patients With Acute Myocardial Infarction

Use of Lipid-Lowering Medications at Discharge in Patients With Acute Myocardial Infarction

Use of cardiovascular drugs by home-dwelling coronary patients aged 75 years and older

Low-Density Lipoprotein, Non-High-Density Lipoprotein, and Apolipoprotein B as Targets of Lipid-Lowering Therapy

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