Secondary prevention and referral of elderly patients to a cardiovascular lipid service

The burden of cardiovascular disease in the elderly has increased interest in lipid profiles which retain associations with outcome except at extreme age and for which management has benefits at least in secondary prevention. The source, clinical and laboratory background of 90 male and 120 female c onsecutive referrals age > 70 years to a specialist cardiovascular lipid se rvice have been analysed. Main sources were vascular surgery 47%, cardiolog y 9% and general practice 41% with 6% referred through routine health check s. Presenting lipids (mM: mean +/- S.D.) were: males: cholesterol 6.9 +/- 1 .7, triglycerides 2.3 +/- 1.5, HDL 1.2 +/- 0.3; females: cholesterol 7.8 +/ - 1.4, triglycerides 2.1 +/- 1.3, HDL 1.5 +/- 0.5, consistent with greater awareness of lipid-related problems in males but significant vascular disea se in females. Secondary lipemia was defined in 131/210, 62.3% of patients (83 recognised before clinic presentation, 48 found at follow-up, mainly di abetes). Significant vascular disease was identified in 166/210 patients, s ignificant other risk factors in another 35 patients. Levels of lipoprotein (a) were widely distributed for all groups, but elevated against population profiles for all groups with vascular disease. Referrals were monitored an d not routinely accepted: reassuringly most then accepted were justified th rough atheroma-related disease and opportunities for secondary prevention, with little additional burden through untargeted routine health checks. Rec ognition of and management of secondary lipemia and obesity were however in complete. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.