TIME TRENDS IN THE USE OF CHOLESTEROL-LOWERING AGENTS IN OLDER ADULTS- THE CARDIOVASCULAR HEALTH STUDY

Objectives: To describe recent temporal patterns of cholesterol-loweri ng medication use and the characteristics that may have influenced the initiation of cholesterol-lowering therapy among those aged 65 years or older. Subjects and Methods: A cohort of 5201 adults 65 years or ol der were examined annually between June 1989 and May 196. We added 687 African American adults to the cohort in 1992-1993. We measured blood lipid levels at baseline and for the original cohort in the third yea r of follow-up. We assessed the use of cholesterol-lowering drugs at e ach visit. Results: The prevalence of cholesterol-lowering drug use in 1989-1990 was 4.5% among the men and 5.9% among the women; these figu res increased over the next 6 years to 8.1% and 10.0%, respectively, i n 1995-1996. There was a 4-fold increase in the use of 3-hydroxy-3-met hylglutaryl coenzyme A (HMG-CoA) reductase inhibitors during the 6 yea rs of follow-up, from 1.9% of all participants in 1989-1990 to 7.5% in 1995-1996. The use of bile acid sequestrants, nicotinic acid, and pro bucol declined from initial levels of less than 1% each. Among the par ticipants who were untreated in 1989-1990, but eligible for cholestero l-lowering therapy after a trial of dietary therapy according to the 1 993 guidelines of the National Cholesterol Education Panel, less than 20% initiated drug therapy in the 6 years of follow-up, even among sub jects with a history of coronary heart disease. Among participants unt reated at baseline but eligible for either cholesterol-lowering therap y or dietary therapy, initiation of cholesterol-lowering drug therapy was directly associated with total cholesterol levels, hypertension, a nd a history of coronary heart disease, and was inversely related to a ge, high-density lipoprotein cholesterol levels, and difficulties with activities of daily living. Other characteristics that form the basis of the 1993 National Cholesterol Education Panel guidelines-diabetes, smoking, family history of premature coronary heart disease, and tota l number of risk factors-were not associated with the initiation of ch olesterol-lowering drug therapy. Conclusions: Given the clinical trial evidence for benefit, those aged 65 to 75 years and with prior corona ry heart disease appeared undertreated with cholesterol-lowering drug therapy.