Cholesterol lowering in the older population: time for reassessment?

Hypercholesterolaemia is an established major risk factor for coronary hear t disease (CHD) in the general population. In the vast majority of studies that focused on this particular age group and carefully eliminated other co nfounding factors such as co-morbid conditions, hypercholesterolaemia was a risk factor for CHD in the older population. Because the prevalence of CHD increases with advancing age, studies that consider not only the relative risk attributed to cholesterol but also the absolute numbers of people affe cted, show hypercholesterolaemia to be an even stronger risk factor in the elderly. Large primary and secondary prevention studies of HMG-CoA reductas e inhibitors (statins) in the elderly have shown a reduction in major coron ary events similar to that observed in the younger age group. The role of h ypercholesterolaemia as a risk factor for stroke is less clear, and a major limitation is the heterogeneous nature of the disease. Nevertheless, most studies that evaluated non-haemorrhagic strokes separately showed a positiv e association with cholesterol levels, and statin therapy is effective in p reventing stroke. These data provide a rationale for treating older hyperch olesterolaemic people with statins, not only to prevent CHD, but also to pr event stroke.