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[Hyperlipidemia in the elderly].

UNLABELLED
THE ELDERLY SUBJECT: Cardiovascular prevention trials have clearly established the beneficial effect of lipid-lowering drugs, basically statins, for adults, and in particular for adult males. There has not however been any study specifically analyzing prevention in the elderly. In addition, the relationships between high cholesterol level and cardiovascular risk in the elderly subject are complex and require specific adaptation with markers of poor health status.


PREVENTIVE MEASURES
Even though the relationship between elevated total cholesterol or LDL-cholesterol and cardiovascular risk is difficult to demonstrate in the elderly, analyses of subpopulations are beginning to show evidence that a lipid-lowering treatment can have a beneficial preventive effect in the elderly. Other research avenues also point to perspectives for stroke prevention or reduced risk of dementia in patients treated with statins.


RECOMMENDATIONS
Until the results of ongoing clinical trials become available, recommendations for therapeutic strategies in the elderly are basically founded on clinical experience in light of current evidence. It is reasonable to recommend a lipid-lowering regimen for secondary prevention and to continue treatment beyond 70 years for primary prevention if the patient's overall cardiovascular risk warrants prevention. But, on the basis of current evidence, there is no rationale for recommending a large screening of hypercholesterolemia in primary prevention in subjects over 70 years of age. Likewise, taking into account associated disease states and the increased risk of drug interactions, primary prevention regimens cannot be recommended except for elderly patients with a high overall cardiovascular risk.