Paul Candon, Medical Tribune News Service
Older Americans, even those with no apparent heart problems,
should make an effort to control their cholesterol, according to
researchers in Maryland.
High cholesterol can cause atherosclerosis, a condition in which
fat and cholesterol deposits clog arteries, including the arteries
that provide blood to the heart. When oxygen-enriched blood cannot
reach the heart in sufficient supply, coronary heart disease (CHD)
is the result. Two-thirds to three-quarters of Americans age 65 and
older have either CHD or the beginnings of atherosclerosis.
``Controlling cholesterol produces significant benefits in the
elderly,'' said Dr. James Cleeman, coordinator of the National
Cholesterol Education Program (NCEP) and co-author of a review
article that appeared in the Aug. 9/23 edition of the biweekly
Archives of Internal Medicine. ``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 risk of developing CHD.''
According to the report, Americans older than 65 should be
physically active, maintain a healthy weight and eat foods lower in
saturated fat, total fat and cholesterol. The authors also
recommended that all Americans older than age 20, especially
seniors, have their cholesterol checked every five years. In this
manner, people can help prevent CHD before it begins.
Other high-risk factors for developing CHD are smoking, high
blood pressure, physical inactivity, obesity and diabetes. Elderly
persons should attempt to reduce these risk factors and make
cholesterol-lowering lifestyle changes in order to decrease the
overall risk of CHD, the authors said. If high-risk patients cannot
reduce cholesterol levels through lifestyle changes, the authors
recommended that physicians consider prescribing
cholesterol-lowering medication. Life-habit changes and medication
were also recommend for seniors who already have CHD.
Dr. Basil Rifkind, senior scientific advisor at the National
Heart, Lung and Blood Institute in Bethesda, Md., and co-author of
the report, said that in the past, those 65 and older were not
aggressively treated for high cholesterol because some doctors
thought it was ``too late'' for treatment to be useful.
With the evidence that has accumulated, ``we can no longer take
that position,'' Rifkind said. ``There has been a revolution in the
past five or six years in cholesterol treatment. Medications called
statins have proven very safe and effective in lowering cholesterol
levels.''
``What [the NCEP is] doing now is not something new _ they're
just changing their minds,'' said Dr. Bruce A. Kottke, a consultant
in peripheral vascular diseases at Watson Clinic, Lakeland, Fla.,
and professor emeritus and previous director of a specialized
atherosclerosis research center at Mayo Clinic, Rochester, Minn.
The conclusions in this report are nothing new, he said. ``[The
people at the NCEP] have been the last ones to change their minds.
They have been holding things up for years and years.''
Kottke said that some cases of high cholesterol have a strong
genetic component that cannot be mediated with diet changes. He
noted that in these, and many other cases of high cholesterol,
statins are an important, lifesaving treatment, and denying such
patients these medications would nearly constitute malpractice.
According to Kottke, much of the information in the report ``is
really badly dated. These people obviously are not up to date on
the field.''
Kottke also pointed out that the authors did not discuss
triglycerides in the report. Triglycerides and cholesterol are the
two major lipids, or fats, found in the blood. ``They [the NCEP]
have been downplaying triglycerides for the past 20 years,'' he
said, ``in spite of an enormous amount of evidence that it is a
significant risk factor [in CHD].''
The report's authors gathered evidence from numerous studies and
clinical trials, and concluded that prevention and control of high
cholesterol would be beneficial to the elderly population in
general by reducing the overall risk for CHD.
