Treatment of older persons with hypercholesterolemia with and without cardiovascular disease

Hypercholesterolemia is a risk factor for new coronary events in older men and women. Secondary prevention trials have demonstrated in persons with co ronary artery disease (CAD) and hypercholesterolemia that statin drugs redu ced in older persons all-reuse mortality, cardiovascular mortality, coronar y events, coronary revascularization. stroke, and intermittent claudication . Statins have also been shown to slow progression of coronary atherosclero tic plaques in persons with CAD, to reduce restenosis after coronary stent implantation, and to decrease myocardial ischemia in persons with CAD. Olde r men and women with CAD, prior atherothrombotic brain infarction, peripher al arterial disease, or extracranial carotid arterial disease and a serum l ow-density lipoprotein (LDL) cholesterol level higher than 125 mg/dl despit e diet should be treated with statin drug therapy to loner the serum LDL ch olesterol level below 100 mg/dl. Primary prevention trials have shown that statins were also effective in reducing cardiovascular events in older pers ons with hypercholesterolemia. On the basis of data from the Air Force/Texa s Coronary Atherosclerosis Prevention Study, the physician should consider using statins in persons aged 65-80 years without cardiovascular disease wi th a serum LDL cholesterol level above 130 mg/dl and serum high-density lip oprotein cholesterol level below 50 mg/dl.