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Treatment of Older Persons With Hypercholesterolemia With and Without Cardiovascular Disease

^a Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York
^b Department of Medicine, Hebrew Hospital Home, Bronx and Valhalla, New York

Wilbert S. Aronow, Corporate Medical Director, Hebrew Hospital Home, 801 Co-op City Blvd., Bronx, NY 10475. Telephone: (718) 239-6488 fax: (718) 239-6492 E-mail: WSAronow{at}aol.com.

Decision Editor: John E. Morley, MB, BCh

Hypercholesterolemia is a risk factor for new coronary events in older men and women. Secondary prevention trials have demonstrated in persons with coronary artery disease (CAD) and hypercholesterolemia that statin drugs reduced in older persons all-cause mortality, cardiovascular mortality, coronary events, coronary revascularization, stroke, and intermittent claudication. Statins have also been shown to slow progression of coronary atherosclerotic plaques in persons with CAD, to reduce restenosis after coronary stent implantation, and to decrease myocardial ischemia in persons with CAD. Older men and women with CAD, prior atherothrombotic brain infarction, peripheral arterial disease, or extracranial carotid arterial disease and a serum low-density lipoprotein (LDL) cholesterol level higher than 125 mg/dl despite diet should be treated with statin drug therapy to lower the serum LDL cholesterol level below 100 mg/dl. Primary prevention trials have shown that statins were also effective in reducing cardiovascular events in older persons with hypercholesterolemia. On the basis of data from the Air Force/Texas Coronary Atherosclerosis Prevention Study, the physician should consider using statins in persons aged 65–80 years without cardiovascular disease with a serum LDL cholesterol level above 130 mg/dl and serum high-density lipoprotein cholesterol level below 50 mg/dl.

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