ASK DR. BAUGHAN                                             October 27, 2000

VINTAGE CHOLESTEROL

Monitoring cholesterol levels has become a ritual of health care in the past twenty years.  The original studies that showed some benefits of treating cholesterol in the prevention of heart attacks studied men between the ages of 40 and 50.  There were several reasons for this.  Men have more heart attacks than women during this decade.  When those studies were done, there was a clear bias toward studying men in research (dare I say this might relate to the fact that it is mostly men who approve the money for research projects?).  Also, there was the rationale that preventing heart attacks in this decade might give much more years of additional life than studying older people.

As the population ages, however, more attention has begun to shift to older persons and the role of cholesterol.  The benefits of having a lower cholesterol have been documented in more studies of men and women of a wider range of ages.  We can start to give information to our “vintage citizens” with some research to back it up.  There is a good summary of our current state of knowledge in an article by C.M. Carlsson in the Journal of the American Geriatrics Society in December 1999 entitled, “Managing Dyslipidemia in older adults.”

Should we check cholesterol levels lifelong?  Total cholesterol and LDL cholesterol levels level off in most men around 50 years old.  Women plateau around 60.  So if you have had normal levels all your life, you may not need to continue checking after those ages, or certainly less frequently.

Does a high cholesterol carry the same heart disease risk lifelong?  The Framingham Heart Study has found that elevated cholesterol levels in those age 65 to 85 did have a higher risk of heart attacks.  The level that seemed to be important was over 306 mg/dl, considerably higher than the level in younger patients, though.  More studies may better clarify which levels warrant attention.  Over 85, the association between high cholesterol and heart attacks was not present according to current data.  Maybe if you get to 85, you’ve clearly got good genes against heart disease.

Does lowering cholesterol still help prevent heart attacks in the elderly?  Here the research gets more patchy.  If you have never had heart trouble, we have to say, “We don’t know.”  If you have had angina or a heart attack, though, the answer is clearly, “Yes.”  In the 40-50 year old crowd, you had to treat 100 people to prevent one heart attack.  In the over 65 group, you prevent one heart attack out of every 10-24 people treated.

Do the medicines cause more trouble in the elderly?  They do not seem to.  The safety of the statins seems to hold up in older persons well.  They do not have a lot of interactions with other medicines that the elderly are likely to be taking for other problems.  There are no more liver problems.  One speaker at a recent conference responded this way when asked whether elderly patients should be treated with medication:  “Ask your patient if they want you to perform CPR on them if they have a cardiac arrest.  If they do, then why not treat them with a medicine that can help prevent a cardiac arrest?”

Diet and exercise continue to play an important role in cholesterol control throughout a lifetime, also.  So it is just as important, if not more so, to continue to be active and eat sensibly, not just take pills, for all our years.