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November 2, 1994, Vol 272, No. 17 >
ARTICLE | November 2, 1994

Cholesterol in the Elderly: Title and subTitle BreakIs It Important? FREE

Stephen B. Hulley, MD, MPH; Thomas B. Newman, MD, MPH
[+] Author Affiliations

Reprint requests to the University of California, San Francisco, UCSF Box 0560, San Francisco, CA 94193 (Dr Hulley).


JAMA. 1994;272(17):1372-1374. doi:10.1001/jama.1994.03520170082041
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References

There is a growing tendency to encourage measurement of and treatment for high blood cholesterol levels in elderly people. The 1993 adult treatment guidelines from the National Cholesterol Education Program (NCEP) note an "enhanced recognition [since 1988] that... high-risk elderly patients who are otherwise in good health are candidates for cholesterol-lowering therapy."1 This policy shift is based on the belief that the association between blood cholesterol and coronary heart disease (CHD) persists after age 65 years and on a growing willingness to extrapolate to older people the reduced CHD rates observed in clinical trials of hypolipidemic treatment in middle-aged men.

See also p 1335.

In this issue of The Journal, the contention that an association between cholesterol and CHD persists in the elderly is called into question in a report by Krumholz et al.2 The report finds no association between blood cholesterol level and CHD incidence or death

REFERENCES

1 +
Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.  Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA . 1993;;269:3015-3023.
2 +
Krumholz HM, Seeman TE, Merrill SS, et al.  Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older than 70 years. JAMA . 1994;;272:1335-1340.
3 +
Gordon D, Rifkind B.  Treating high blood cholesterol in the older patient. Am J Cardiol . 1989;;63( (suppl) ):48H-52H.
4 +
Manolio TA, Pearson TA, Wenger NK, Barrett-Connor E, Payne GH, Harlan WR.  Cholesterol and heart disease in older persons and women: review of an NHLBI workshop. Ann Epidemiol . 1992;;2:161-176.
5 +
Kronmal RA, Cain KC, Ye Z, Omenn GS.  Total serum cholesterol levels and mortality risk as a function of age: a report based on the Framingham data. Arch Intern Med . 1993;;153:1065-1073.
6 +
Casiglia E, Spolaore P, Ginocchio G, et al.  Predictors of mortality in very old subjects aged 80 years or over. Eur J Epidemiol . 1993;;9:577-586.
7 +
Weijenberg MP, Feskens EJM, Bowles CH, Kromhout D.  Serum total cholesterol and systolic blood pressure as risk factors for mortality from ischemic heart disease among elderly men and women. J Clin Epidemiol . 1994;;47:197-205.
8 +
Evidence-Based Medicine Working Group.  Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA . 1992;;268:2420-2425.
9 +
US Preventive Services Task Force. Guide to Clinical Preventive Services . Baltimore, Md: Williams & Wilkins; 1989;:xix-xxxviii.
10 +
Eddy DM.  Practice policies: where do they come from? JAMA . 1990;;263:1265-1268.
11 +
Wallace RR, Colsher PL.  Blood lipid distributions in older persons: prevalence and correlates of hyperlipidemia. Ann Epidemiol . 1992;;2:15-21.
12 +
Davis C, Rifkind B, Brenner H, Gordon D.  A single cholesterol measurement underestimates the risk of CHD. JAMA . 1990;;264:3044-3046.
13 +
Rubin SM, Sidney S, Black DM, Browner WS, Hulley SB, Cummings SR.  High blood cholesterol in elderly men and the excess risk for CHD. Ann Intern Med . 1990;;113:916-920.
14 +
Hulley SB, Newman TB, Grady D, Garber AM, Baron RB, Browner WS.  Should we be measuring blood cholesterol levels in young adults? JAMA . 1993;;269:1416-1419.
15 +
Sempos CT, Cleeman JI, Carroll MD, et al.  Prevalence of high blood cholesterol among US adults. JAMA . 1993;;269:3009-3014.
16 +
Hunninghake DB, Stein EA, Dujovne CA, et al.  The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia. N Engl J Med . 1993;;328:1213-1219.
17 +
Ramsay LE, Yeo WW, Jackson PR.  Dietary reduction of serum cholesterol concentration: time to think again. BMJ . 1991;;303:953-957.
18 +
Ettinger WH, Wahl PW, Kuller LH, et al.  Lipoprotein lipids in older people: results from the Cardiovascular Health Study. Circulation . 1992;;86:858-869.
19 +
Giles WH, Anda RF, Jones DH, Serdula MK, Merritt RK, DeStefano F.  Recent trends in the identification and treatment of high blood cholesterol by physicians: progress and missed opportunities. JAMA . 1993;;269:1133-1138.
20 +
Hulley SB, Walsh JMB, Newman TB.  Health policy on blood cholesterol: time to change directions. Circulation . 1992;;86:1026-1029.
21 +
Jacobs D, Blackburn H, Higgins M, et al.  Report of the Conference on Low Blood Cholesterol: mortality associations. Circulation . 1992;;86:1046-1060.
22 +
Harris T, Kleinman JC, Ettinger WH, Makuc DM, Schatzkin AG.  The low cholesterol-mortality association in a national cohort. J Clin Epidemiol . 1992;;45: 595-601.
23 +
Davey Smith G, Song F, Sheldon TA.  Cholesterol lowering and mortality: the importance of considering initial level of risk. BMJ . 1993;;306:1367-1373.
24 +
Hulley SB, Newman TB, Jacobs DA.  Toward a more balanced cholesterol policy. Circulation . In press.
25 +
Huttunen JK, Heinonen OP, Manninen V, et al.  The Helsinki Heart Study: an 8.5-year safety and mortality follow-up. J Intern Med . 1994;;235:31-39.
26 +
Heady JA, Morris JN, Oliver MF.  WHO clofibrate/cholesterol trial: clarifications. Lancet . 1992;;340:1405-1406.
27 +
Garber A, Littenberg B, Sox H, Wagner J, Gluck M.  Costs and health consequences of cholesterol screening for asymptomatic older Americans. Arch Intern Med . 1991;;151:1089-1095.
28 +
Dayton S, Chapman JM, Pearce ML, Popjak GJ.  Cholesterol, atherosclerosis, ischemic heart disease, and stroke. Ann Intern Med . 1970;;72:97-109.
29 +
Pearce ML, Dayton S.  Incidence of cancer in men on a diet high in polyunsaturated fat. Lancet . 1971;;1:464-467.
30 +
Pitt B, Furberg C, McGovern M. Reduction in cardiovascular events during treatment with pravastatin: pooled analysis from coronary and carotid atherosclerosis intervention trials. Presented at the Joint 12th World Congress of Cardiology and 16th Congress of the European Society of Cardiology; 1994; Berlin, Germany.
31 +
LaRosa JC, Applegate W, Crouse JR, et al.  Cholesterol lowering in the elderly: results of the Cholesterol Reduction in Seniors Program (CRISP) pilot study. Arch Intern Med . 1994;;154:529-539.

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1 +
Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.  Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA . 1993;;269:3015-3023.
2 +
Krumholz HM, Seeman TE, Merrill SS, et al.  Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older than 70 years. JAMA . 1994;;272:1335-1340.
3 +
Gordon D, Rifkind B.  Treating high blood cholesterol in the older patient. Am J Cardiol . 1989;;63( (suppl) ):48H-52H.
4 +
Manolio TA, Pearson TA, Wenger NK, Barrett-Connor E, Payne GH, Harlan WR.  Cholesterol and heart disease in older persons and women: review of an NHLBI workshop. Ann Epidemiol . 1992;;2:161-176.
5 +
Kronmal RA, Cain KC, Ye Z, Omenn GS.  Total serum cholesterol levels and mortality risk as a function of age: a report based on the Framingham data. Arch Intern Med . 1993;;153:1065-1073.
6 +
Casiglia E, Spolaore P, Ginocchio G, et al.  Predictors of mortality in very old subjects aged 80 years or over. Eur J Epidemiol . 1993;;9:577-586.
7 +
Weijenberg MP, Feskens EJM, Bowles CH, Kromhout D.  Serum total cholesterol and systolic blood pressure as risk factors for mortality from ischemic heart disease among elderly men and women. J Clin Epidemiol . 1994;;47:197-205.
8 +
Evidence-Based Medicine Working Group.  Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA . 1992;;268:2420-2425.
9 +
US Preventive Services Task Force. Guide to Clinical Preventive Services . Baltimore, Md: Williams & Wilkins; 1989;:xix-xxxviii.
10 +
Eddy DM.  Practice policies: where do they come from? JAMA . 1990;;263:1265-1268.
11 +
Wallace RR, Colsher PL.  Blood lipid distributions in older persons: prevalence and correlates of hyperlipidemia. Ann Epidemiol . 1992;;2:15-21.
12 +
Davis C, Rifkind B, Brenner H, Gordon D.  A single cholesterol measurement underestimates the risk of CHD. JAMA . 1990;;264:3044-3046.
13 +
Rubin SM, Sidney S, Black DM, Browner WS, Hulley SB, Cummings SR.  High blood cholesterol in elderly men and the excess risk for CHD. Ann Intern Med . 1990;;113:916-920.
14 +
Hulley SB, Newman TB, Grady D, Garber AM, Baron RB, Browner WS.  Should we be measuring blood cholesterol levels in young adults? JAMA . 1993;;269:1416-1419.
15 +
Sempos CT, Cleeman JI, Carroll MD, et al.  Prevalence of high blood cholesterol among US adults. JAMA . 1993;;269:3009-3014.
16 +
Hunninghake DB, Stein EA, Dujovne CA, et al.  The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia. N Engl J Med . 1993;;328:1213-1219.
17 +
Ramsay LE, Yeo WW, Jackson PR.  Dietary reduction of serum cholesterol concentration: time to think again. BMJ . 1991;;303:953-957.
18 +
Ettinger WH, Wahl PW, Kuller LH, et al.  Lipoprotein lipids in older people: results from the Cardiovascular Health Study. Circulation . 1992;;86:858-869.
19 +
Giles WH, Anda RF, Jones DH, Serdula MK, Merritt RK, DeStefano F.  Recent trends in the identification and treatment of high blood cholesterol by physicians: progress and missed opportunities. JAMA . 1993;;269:1133-1138.
20 +
Hulley SB, Walsh JMB, Newman TB.  Health policy on blood cholesterol: time to change directions. Circulation . 1992;;86:1026-1029.
21 +
Jacobs D, Blackburn H, Higgins M, et al.  Report of the Conference on Low Blood Cholesterol: mortality associations. Circulation . 1992;;86:1046-1060.
22 +
Harris T, Kleinman JC, Ettinger WH, Makuc DM, Schatzkin AG.  The low cholesterol-mortality association in a national cohort. J Clin Epidemiol . 1992;;45: 595-601.
23 +
Davey Smith G, Song F, Sheldon TA.  Cholesterol lowering and mortality: the importance of considering initial level of risk. BMJ . 1993;;306:1367-1373.
24 +
Hulley SB, Newman TB, Jacobs DA.  Toward a more balanced cholesterol policy. Circulation . In press.
25 +
Huttunen JK, Heinonen OP, Manninen V, et al.  The Helsinki Heart Study: an 8.5-year safety and mortality follow-up. J Intern Med . 1994;;235:31-39.
26 +
Heady JA, Morris JN, Oliver MF.  WHO clofibrate/cholesterol trial: clarifications. Lancet . 1992;;340:1405-1406.
27 +
Garber A, Littenberg B, Sox H, Wagner J, Gluck M.  Costs and health consequences of cholesterol screening for asymptomatic older Americans. Arch Intern Med . 1991;;151:1089-1095.
28 +
Dayton S, Chapman JM, Pearce ML, Popjak GJ.  Cholesterol, atherosclerosis, ischemic heart disease, and stroke. Ann Intern Med . 1970;;72:97-109.
29 +
Pearce ML, Dayton S.  Incidence of cancer in men on a diet high in polyunsaturated fat. Lancet . 1971;;1:464-467.
30 +
Pitt B, Furberg C, McGovern M. Reduction in cardiovascular events during treatment with pravastatin: pooled analysis from coronary and carotid atherosclerosis intervention trials. Presented at the Joint 12th World Congress of Cardiology and 16th Congress of the European Society of Cardiology; 1994; Berlin, Germany.
31 +
LaRosa JC, Applegate W, Crouse JR, et al.  Cholesterol lowering in the elderly: results of the Cholesterol Reduction in Seniors Program (CRISP) pilot study. Arch Intern Med . 1994;;154:529-539.

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