Screening for coronary heart disease in elderly men based on current and past cholesterol levels

Efficient use of cholesterol measurements to screen for coronary heart dise ase in the elderly is not well defined. The purpose of this report is to ex amine such screening based on national guidelines in a sample of older men. Since relations between cholesterol and coronary heart disease are better established in those who are younger, screening in the elderly will also co nsider levels of cholesterol that existed earlier in life. Data are from a prospective study of 1,170 men enrolled in the Honolulu Heart Program who w ere followed over a 12-year period for coronary heart disease. Follow-up be gan from 1980 to 1982, when cholesterol levels were determined in men who w ere aged 61 to 81 years. Past cholesterol levels were measured 10 years ear lier (1970-1972). During the course of follow-up, coronary heart disease de veloped in 117 of the men. Risk of disease rose significantly (P = 0.003) w ith increases in past cholesterol levels (1970-1972) but not with more rece nt levels (1980-1982). For men with current cholesterol levels that were de sirable (<5.2 mmol/L [200 mg/dl], as defined by guidelines from the Nationa l Cholesterol Education Program), disease incidence continued to rise with increasing past cholesterol levels (P < 0.001). Accounting for high-density lipoprotein cholesterol and other screening factors did little to alter th ese findings. We conclude that desirable cholesterol levels in the elderly may not be a marker of a healthy risk profile if past cholesterol levels we re high. Screening fur coronary heart disease in the elderly could be impro ved by considering past cholesterol levels, rather than just a single measu rement in later life. (C) Elsevier Science Inc.