[Decisions regarding cholesterol-lowering therapy in the elderly: the experience in a lipid clinic and a review of the literature].
BACKGROUND
Therapy for hypercholesterolemia is long known one of the interventions with higher benefit on coronary heart disease secondary prevention and on primary prevention in middle-age high-risk people. Data about elderly persons are more scarce. The aim of this work is to study elderly patients sent to a Lipid Clinic, focusing on Serum Lp (a) levels and criteria to prescript cholesterol-lowering drugs. We have reviewed current knowledge to discuss and to clarify these criteria.


METHODS
Observational study. Review of the medical charts from the patients sent to the Lipid Clinic. Elderly patients were compared with middle-aged persons attended to the same Clinic.


RESULTS
From 348 total Lipid-Clinic cohort 72 (20.7%) patients were more than 65 years old (31 male). A 3 months or longer follow-up was available in 49/72 and 36/49 were taking cholesterol-lowering drugs. Among these 36, 21 had coronary disease; the other 15 had, at least, another risk factor, besides dyslipidemia. Serum Lp (a) level were higher in older group (38.7 +/- 36.9 mg/dl, median 29, vs 26.3 +/- 24.2, median 18 mg/dl, p < 0.01). Considering the accepted cardiovascular risk threshold (Lp (a) > 30 mg/dl), difference were found only in women. Coronary disease was present in 79 patients followed 3 months or longer and 24/79 were more than 65 years old. Twenty-one of them were taking cholesterol-lowering drugs, vs 50 from the 55 younger (pNS). The reasons for no drug-therapy were similar in both groups.


CONCLUSIONS
Coronary heart disease or cardiovascular risk factors association were the criteria used for starting cholesterol-lowering drug therapy. Published evidence supporting this therapeutic approach is reviewed. There were not found age related differences for cholesterol-lowering drugs prescriptions in patients suffering coronary disease. Serum Lp (a) level were higher in elderly sample because of the increase in older women; it could be linked to the postmenopausal hormonal state.
Garrido Sanjuán
J A
JA
Unidad de Lípidos, Hospital Arquitecto Marcide-Novoa Santos, Ferrol, La Coruña.
Pía Iglesias
G
G
González Moraleja
J
J
Sesma
P
P
D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood; D008297:Male; D012307:Risk Factors
D000960:Hypolipidemic Agents; D008055:Lipids
Indicaciones del tratamiento hipolipemiante en el anciano: experiencia de una unidad de lípidos y revisión de la literatura.