Garrido Sanjuán J A, Pía Iglesias G, González Moraleja J, Sesma P
Unidad de Lípidos, Hospital Arquitecto Marcide-Novoa Santos, Ferrol, La Coruña.
An Med Interna. 1998 Jun;15(6):305-10.
Therapy for hypercholesterolemia is long known one of the interventions with higher benefit on coronary heart disease secondary prevention and on primary prevention in middle-age high-risk people. Data about elderly persons are more scarce. The aim of this work is to study elderly patients sent to a Lipid Clinic, focusing on Serum Lp (a) levels and criteria to prescript cholesterol-lowering drugs. We have reviewed current knowledge to discuss and to clarify these criteria.
Observational study. Review of the medical charts from the patients sent to the Lipid Clinic. Elderly patients were compared with middle-aged persons attended to the same Clinic.
From 348 total Lipid-Clinic cohort 72 (20.7%) patients were more than 65 years old (31 male). A 3 months or longer follow-up was available in 49/72 and 36/49 were taking cholesterol-lowering drugs. Among these 36, 21 had coronary disease; the other 15 had, at least, another risk factor, besides dyslipidemia. Serum Lp (a) level were higher in older group (38.7 +/- 36.9 mg/dl, median 29, vs 26.3 +/- 24.2, median 18 mg/dl, p < 0.01). Considering the accepted cardiovascular risk threshold (Lp (a) > 30 mg/dl), difference were found only in women. Coronary disease was present in 79 patients followed 3 months or longer and 24/79 were more than 65 years old. Twenty-one of them were taking cholesterol-lowering drugs, vs 50 from the 55 younger (pNS). The reasons for no drug-therapy were similar in both groups.
Coronary heart disease or cardiovascular risk factors association were the criteria used for starting cholesterol-lowering drug therapy. Published evidence supporting this therapeutic approach is reviewed. There were not found age related differences for cholesterol-lowering drugs prescriptions in patients suffering coronary disease. Serum Lp (a) level were higher in elderly sample because of the increase in older women; it could be linked to the postmenopausal hormonal state.
长期以来，高胆固醇血症的治疗一直是对冠心病二级预防以及中年高危人群一级预防益处较大的干预措施之一。关于老年人的数据则更为稀少。本研究的目的是对送至血脂门诊的老年患者进行研究，重点关注血清脂蛋白（a）水平以及开具降胆固醇药物的标准。我们回顾了现有知识以讨论并阐明这些标准。
观察性研究。回顾送至血脂门诊患者的病历。将老年患者与在同一门诊就诊的中年患者进行比较。
在血脂门诊的348名患者队列中，72名（20.7%）患者年龄超过65岁（31名男性）。49/72的患者有3个月或更长时间的随访，其中36/49正在服用降胆固醇药物。在这36名患者中，21名患有冠心病；另外15名除血脂异常外，至少还有另一个危险因素。老年组的血清脂蛋白（a）水平更高（38.7±36.9mg/dl，中位数29，而对照组为26.3±24.2，中位数18mg/dl，p<0.01）。考虑到公认的心血管风险阈值（脂蛋白（a）>30mg/dl），仅在女性中发现差异。在随访3个月或更长时间的79名患者中，有79名患有冠心病，其中24/79年龄超过65岁。他们中有21名正在服用降胆固醇药物，而55名较年轻患者中有50名服用（p无统计学意义）。两组未进行药物治疗的原因相似。
冠心病或心血管危险因素的存在是开始降胆固醇药物治疗的标准。对支持这种治疗方法的已发表证据进行了回顾。在患有冠心病的患者中，未发现降胆固醇药物处方存在年龄相关差异。老年样本中血清脂蛋白（a）水平较高是因为老年女性数量增加；这可能与绝经后激素状态有关。
