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Cholesterol and Coronary Heart Disease Risk in Elderly Patients-Reply FREE

Stephen B. Hulley, MD, MPH; Thomas B. Newman, MD, MPH
JAMA. 1995;273(17):1331-1331. doi:10.1001/jama.1995.03520410023012
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In Reply.  —Dr Harris and colleagues note that "busy practitioners" may be "left with the impression that lipoprotein lipids are not risk factors for older people." This would be rational, since this is the empirical observation. We do agree with Harris et al that the paradoxical inverse association between blood cholesterol and mortality, which extends to the upper half of the cholesterol distribution in the elderly,1 may not be causal. Their hypothesis that this association would go the other way were it not for an interaction with prior health status is intriguing, but only one of the possible explanations, only partly supported in their own studies,2 and still to be examined elsewhere.Two other issues raised by Harris et al deserve comment. One is their use of the LaRosa et al reference, from which they concluded that lipid treatment is not hazardous in the elderly. That was a

REFERENCES

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.
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.
US Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions . Baltimore, Md: Williams & Wilkins Co; 1989;:xix-xxxviii.
Canadian Task Force.  Periodic Health Examination, 1993 update 2: lowering the blood total cholesterol level to prevent CHD. Can Med Assoc J . 1993;;148:521-538.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

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.
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.
US Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions . Baltimore, Md: Williams & Wilkins Co; 1989;:xix-xxxviii.
Canadian Task Force.  Periodic Health Examination, 1993 update 2: lowering the blood total cholesterol level to prevent CHD. Can Med Assoc J . 1993;;148:521-538.
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To understand the clinical management of acute heart failure syndromes.
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