Is hypercholesterolemia a risk factor and should it be treated in the elderly?

Purpose. The 1993 National Cholesterol Education Program guidelines recomme nd cholesterol screening for elderly patients with and without known corona ry heart disease. This review summarizes clinical trial evidence from the m edical literature that addresses cholesterol treatment in the elderly. Data Sources. References were obtained from a MEDLINE search, bibliographie s, meta-analyses, and review articles. Study Inclusion and Exclusion Criteria. Randomized controlled clinical tria ls, including all lipid intervention trials with elderly participants or su bgroup analyses of the elderly designed to measure major cardiovascular dis ease endpoints were selected. Data Extraction Methods. A MEDLINE search of all clinical trials using key search terms yielded 1360 references. Journal titles and abstracts were rev iewed for all references by one of us (K.M.H.). A full journal review was u ndertaken for 41 references to clinical trials. Five clinical trials fulfil led all criteria and represented unique data. Data Synthesis. A MEDLINE search (from 1966 to January 2000) and bibliograp hy reviews yielded five important clinical trials with analyses of elderly participants. Data are presented in text form and a summary table. Major Conclusions. Clinical trial evidence supports treating hyperlipidemia in elderly persons for secondary prevention of coronary heart disease. Evi dence from four secondary prevention trials demonstrated that major coronar y heart disease risk decreased by 25% to 30% in elderly subjects treated fo r 5 years. Unanswered questions include cholesterol treatment for primary p revention in the elderly, gender effect, and benefit of treatment in person s older than 70.