Tikkanen M J
Third Department of Medicine, University of Helsinki, Finland.
Eur Heart J. 1988 Mar;9 Suppl D:79-82. doi: 10.1093/eurheartj/9.suppl_d.79.
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.
中年人群的血清总胆固醇水平与冠心病（CHD）发病率呈强正相关。这种相关性在最早期的冠心病病例（40岁以下）中最强，但随着年龄增长而减弱。根据弗雷明汉姆研究，低密度脂蛋白胆固醇在老年人中仍是冠心病的危险因素，尽管影响有所降低，而高密度脂蛋白胆固醇即使在老年时仍是重要的保护因素。低密度脂蛋白胆固醇作为冠心病危险因素的影响降低，这表明血清胆固醇升高的药物治疗在老年人中不如在中年人群中重要。到目前为止，这一点以及可能的药物不良反应为老年人群不进行干预提供了理论依据。然而，出现了具有降低低密度脂蛋白胆固醇和升高高密度脂蛋白胆固醇作用的强效新药（HMG CoA还原酶抑制剂），其特点是患者依从性良好，这表明药物治疗可能对某些老年患者有用。
