Hypercholesterolaemia in the elderly: is drug treatment justified?

Total serum cholesterol levels are strongly positively correlated with the incidence of coronary heart disease (CHD) in middle-aged populations. This correlation is strongest in the most premature cases of CHD (below age 40 years), but diminishes with increasing age. According to the Framingham study, LDL cholesterol remains a CHD risk factor in the elderly, although with reduced impact, and HDL cholesterol continues to be a significant protective factor even in old age. The reduced impact of LDL cholesterol as a risk factor for CHD has been taken to indicate that drug treatment of elevated serum cholesterol is not as important in the elderly as in the middle-aged population. Until now, this and possible adverse drug effects have provided a rationale for non-intervention in the older age groups. However, the emergence of powerful new agents with LDL cholesterol-lowering and HDL-cholesterol-increasing effects (HMG CoA reductase inhibitors), characterized by excellent patient compliance, suggests that drug therapy may be useful for selected elderly patients.