Treatment of high-risk older persons with lipid-lowering drug therapy.
Randomized, double-blind, placebo-controlled studies and observational studies have demonstrated that statins reduce mortality and major cardiovascular events in high-risk persons with hypercholesterolemia. The aim of this study was to review the evidence for treating high-risk older persons with lipid-lowering drugs. A MEDLINE search of the English-language literature published from January 1, 1989, to June 2006 was conducted to review all studies in which lipid-lowering drug therapy was administered to high-risk older persons. The Heart Protection Study showed that statins reduced mortality and major cardiovascular events in high-risk persons, regardless of the initial level of serum lipids, age, or gender. The updated National Cholesterol Education Program (NCEP) III guidelines state that in very-high-risk patients, a serum low-density lipoprotein (LDL) cholesterol level of <70 mg/dL is a reasonable clinical strategy, regardless of age. When a high-risk person has hypertriglyceridemia or low serum high-density lipoprotein cholesterol, consideration can be given to combining a fibrate or nicotinic acid with an LDL cholesterol-lowering drug. For moderately-high-risk persons, the serum LDL cholesterol should be reduced to <100 mg/dL. When LDL cholesterol-lowering drug therapy is used for high-risk persons or moderately-high-risk persons, the serum LDL cholesterol should be reduced at least 30% to 40%. High-risk older persons should be treated with lipid-lowering drugs according to the NCEP III updated guidelines to reduce cardiovascular morbidity and mortality.
Aronow
Wilbert S
WS
Department of Medicine, Divisions of Cardiology, Geriatrics, and Pulmonary/Critical Care, New York Medical College, Valhalla, NY 10595, USA. WSAronow@aol.com
D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D002995:Clofibric Acid / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D015228:Hypertriglyceridemia / Q000188:drug therapy; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D009525:Niacin / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012307:Risk Factors
D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents; D009525:Niacin; D002995:Clofibric Acid