Dyslipidemia in the Elderly: Should it Be Treated?

Abstract

Elderly or older adults constitute a rapidly growing segment of the United States population, thus resulting in an increase in morbidity and mortality related to cardiovascular disease-an increase that is reaching epidemic proportions. Dyslipidemia is a well established risk factor for cardiovascular disease and is estimated to account for more than half of the global cases of coronary artery disease. Despite the increased prevalence of dyslipidemia in the older adult population, controversy persists regarding the benefits of treatment in this group. Epidemiologic studies have shown that dyslipidemia is often underdiagnosed and under treated in this population probably as a result of a paucity of evidence regarding the impact of treatment in delaying the progression of atherosclerotic disease, concerns involving increased likelihood of adverse events or drug interactions,or doubts regarding the cost effectiveness of lipid-lowering therapy in older adults. In conclusion, despite the proven efficacy of lipid-lowering therapy in decreasing cardiovascular morbidity and mortality, these therapies have been underutilized in older patients. IntroductionThe elderly or older adult population constitutes a continuously growing sector of the United States population with a projected 10 million people over the age of 65 in the next 5 years. As the growing older adult population constitutes a larger proportion of the general population, the magnitude of the problem of disability and death from cardiovascular disease (CVD) is reaching epidemic proportions. In 2003, 38% of the 71 million Americans with CVD were older than 65 years. 1 The World Health Organization (WHO) estimates that dyslipidemia is associated with more than half of global cases of coronary artery disease (CAD) accounting for more than 4 million deaths per year. Epidemiologic studies show that a substantial proportionof older adults are dyslipidemic, including persons 80 years and older; however, controversy persists regarding the relative importance of specific dyslipidemias in this population. It has been established that in older adults, dyslipidemia often coexists with diabetes mellitus (DM), hypertension, and obesity, making its management crucial in attempting to decrease cardiovascular risk. The absolute risk associated with dyslipidemia rises substantially with advancing age.Even though dyslipidemia is regarded as one of the most important cardiovascular risk factors in the elderly, much of the relevant data have been derived from large clinical trials comprised of middle-aged patients. However, the association of dyslipidemia and CAD holds true for patients older than 65 years of age. Large population-based studies such as the Established Populations for Epidemiology Studies in the Elderly (EPESE) revealed that elevated total

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