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Cholesterol Lowering in Elderly Reduces Heart Disease and Strokes

Older Americans have the Nation's highest rate of coronary heart disease (CHD) and can benefit greatly from lowering elevated cholesterol, according to a new report from the National Cholesterol Education Program (NCEP). The report notes that cholesterol lowering also has been shown to reduce the risk of strokes.

NCEP is coordinated by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.

The report, which appears in the August 9/23 issue of the Archives of Internal Medicine, makes clear the NCEP's stand on the controversial issue of cholesterol lowering in those age 65 and older.

"Some investigators have questioned the value of testing cholesterol and treating high levels in the elderly," said NHLBI Director Dr. Claude Lenfant. "But an overview of the research shows that cholesterol lowering can improve both the quality and length of life for many older Americans."

"Because most older Americans have cholesterol buildup in their arteries, an elevated cholesterol causes more cases of CHD in the elderly than in any other age group," said Dr. Scott Grundy, Director of the Center for Human Nutrition at The University of Texas Southwestern Medical Center at Dallas and lead author of the NCEP report. "It is clear that cholesterol counts in the elderly."

Dr. James Cleeman, NCEP Coordinator and a coauthor of the report said, "The new report reviews the evidence from epidemiological studies and clinical trials, and concludes that controlling cholesterol produces significant benefits in the elderly. For those with CHD, it can prolong life and dramatically reduce their risk of having a heart attack. For healthy seniors, it will reduce their high risk of developing CHD."

NCEP recommends that older Americans keep their cholesterol in check by following an eating pattern lower in saturated fat, total fat, and cholesterol, being physically active, and maintaining a healthy weight.

High cholesterol is a major risk factor for CHD. It leads to hardening of the arteries, or atherosclerosis, in which cholesterol deposits build up in vessel walls, including the coronary arteries that feed the heart. According to the new report, two-thirds to three-quarters of those over age 65 have either obvious CHD or "silent" atherosclerosis. In the latter form, the person has no symptoms but plaques have formed in arteries.

As noted, older Americans have more CHD than any other age group and suffer more coronary events, such as heart attacks and angina. Most first CHD events strike after age 65, according to the report.

The report notes that, in the past decade, treatment of high cholesterol has expanded and includes a wider range of cholesterol-lowering drugs, especially the statins, which produce the largest reduction in cholesterol levels. The report adds that cholesterol-lowering treatment works for both women and men.

The report's recommendations include:

  • Older Americans should have their total cholesterol tested once every 5 years and, if an accurate measurement is available, their high density lipoprotein (HDL, the "good" cholesterol)--the same recommendation as for all American adults. The test should be done in a medical setting, so the presence of other CHD risk factors can be checked.
  • Those with high cholesterol should take steps to lower it, especially if they also have other CHD risk factors. These include cigarette smoking, high blood pressure, physical inactivity, overweight, and diabetes.
  • For seniors without CHD who need to lower a high cholesterol, the first line of treatment should be the adoption of the healthy life habits noted above--eating a diet lower in saturated fat, total fat, and cholesterol, being physically active, and maintaining a healthy weight.
  • When life habit changes do not sufficiently lower cholesterol and seniors are at high risk for CHD, drug therapy may be advisable. However, physicians should evaluate a patient's overall health status in making that decision.
  • For most seniors with CHD, life habit changes and medication should be used together from the start of treatment.
  • Postmenopausal women who are judged to need drug treatment to reduce their risk for CHD should consider cholesterol-lowering drugs instead of hormone replacement therapy. A study of women with CHD found that a combination of estrogen and progesterone did not reduce the risk of CHD events. By contrast, studies have shown that postmenopausal women at high risk for CHD benefit greatly from treatment with statin drugs.
  • "It is important for older Americans to pay attention to their cholesterol," said NCEP's Cleeman. "Even if you're 70 and feeling fine, you can develop CHD, so you should take action".
  • "Whether you are old or young, cholesterol counts--you can improve your quality of life by caring about your cholesterol," he added.

To arrange an interview about the NCEP report, contact the NHLBI Communications Office at (301) 496-4236.

September is National Cholesterol Education Month and NCEP will launch an expanded Web site to help Americans control their cholesterol. Check it out at www.nhlbi.nih.gov/chd/.

Information provided by NIH.