Aronow W S
Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York, USA.
J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M138-45. doi: 10.1093/gerona/56.3.m138.
Hypercholesterolemia is a risk factor for new coronary events in older men and women. Secondary prevention trials have demonstrated in persons with coronary artery disease (CAD) and hypercholesterolemia that statin drugs reduced in older persons all-cause mortality, cardiovascular mortality, coronary events, coronary revascularization, stroke, and intermittent claudication. Statins have also been shown to slow progression of coronary atherosclerotic plaques in persons with CAD, to reduce restenosis after coronary stent implantation, and to decrease myocardial ischemia in persons with CAD. Older men and women with CAD, prior atherothrombotic brain infarction, peripheral arterial disease, or extracranial carotid arterial disease and a serum low-density lipoprotein (LDL) cholesterol level higher than 125 mg/dl despite diet should be treated with statin drug therapy to lower the serum LDL cholesterol level below 100 mg/dl. Primary prevention trials have shown that statins were also effective in reducing cardiovascular events in older persons with hypercholesterolemia. On the basis of data from the Air Force/Texas Coronary Atherosclerosis Prevention Study, the physician should consider using statins in persons aged 65-80 years without cardiovascular disease with a serum LDL cholesterol level above 130 mg/dl and serum high-density lipoprotein cholesterol level below 50 mg/dl.
高胆固醇血症是老年男性和女性发生新发冠状动脉事件的危险因素。二级预防试验表明，对于患有冠状动脉疾病（CAD）和高胆固醇血症的患者，他汀类药物可降低老年人的全因死亡率、心血管死亡率、冠状动脉事件、冠状动脉血运重建、中风和间歇性跛行。他汀类药物还被证明可减缓CAD患者冠状动脉粥样硬化斑块的进展，减少冠状动脉支架植入后的再狭窄，并减轻CAD患者的心肌缺血。患有CAD、既往有动脉粥样硬化性脑梗死、外周动脉疾病或颅外颈动脉疾病且尽管饮食控制但血清低密度脂蛋白（LDL）胆固醇水平高于125mg/dl的老年男性和女性，应接受他汀类药物治疗，以使血清LDL胆固醇水平降至100mg/dl以下。一级预防试验表明，他汀类药物在降低高胆固醇血症老年人的心血管事件方面也有效。根据空军/德克萨斯冠状动脉粥样硬化预防研究的数据，医生应考虑对年龄在65 - 80岁、无心血管疾病、血清LDL胆固醇水平高于130mg/dl且血清高密度脂蛋白胆固醇水平低于50mg/dl的人群使用他汀类药物。
