Abstract

PURPOSE: It is not clear whether an elevated serum cholesterol level is as important a risk factor for coronary heart disease in the elderly as it is in middle-aged men. This review highlights some aspects of this issue. OBSERVATIONAL STUDIES: The Framingham study showed that after the age of 65 years, serum cholesterol levels are associated with coronary heart disease only in women. The Honolulu (Hawaii) Heart Program, however, found that the same association also occurred in men aged over 65 years. INTERVENTION STUDIES: The Lipid Research Clinics trial and the Helsinki Heart Study both aimed to reduce coronary heart disease mortality by a drug-induced reduction in serum cholesterol levels. Each produced a significant reduction in coronary morbidity and mortality, of 20 and 30%, respectively, but failed to reduce total mortality significantly. Moreover, an increase in violent death (accident or suicide) was reported by the Helsinki study. LENGTH OF SURVIVAL AND CANCER MORTALITY: Elderly patients with moderate hypercholesterolemia have been reported to survive longer than those with a lower cholesterol level. Further, a significant increase in the cancer mortality rate has been observed in hypocholesterolemic subjects. These data have aroused concern about reducing serum cholesterol levels in patients aged over 65 years. CONCLUSIONS: At present, it seems that a moderate reduction of elevated serum cholesterol levels in elderly patients at risk of coronary heart disease may reduce the incidence of this disease and improve the quality of life in the elderly. The proposal needs to be tested by a randomly allocated controlled trial. The longer survival of patients with moderate hypercholesterolemia and the increase in cancer mortality or violent death seen among hypercholesterolemic subjects need to be further evaluated.