Behavior, Health, and Aging

By Stephen B. Manuck; Richard Jennings et al. | Go to book overview

Does hypercholesterolemia promote coronary atherosclerosis in the elderly? Whether yes or no, is cholesterol lowering effective in preventing CHD events in the elderly? Are the cutpoints for treatment used in nonelderly adults also appropriate guidelines for individuals over 65 years of age? Can we afford to pay for the treatment of so many millions of individuals?

In terms of total health and well-being, what is the optimal cholesterol level, and does this value change with age? Because non-CHD causes of death have been linked to low serum cholesterol, might relative hypercholesterolemia correspond with "nutritional robustness" and provide some adaptive advantage in resisting life-threatening non-CHD illness ( Jacobs, Muldoon, & Rastam, 1995)? If so, does cholesterol lowering increase nonCHD morbidity or mortality, or both? Does low or lowered cholesterol affect mood or impulse control, and does treatment cause more depressive illness or suicide? What is the net balance between beneficial and adverse health effects of such cholesterol lowering in the elderly?

In one sense, the last decade has brought substantial advances in researchers' broadening appreciation of the roles of serum lipids in health and disease. However, with many lines of research still in their infancies, this new knowledge has done more to expand the list of questions than to provide answers. This may be more true of the elderly than of any other segment of the population. At present, differences of opinion exist regarding the role of cholesterol lowering to prevent CHD in the elderly. Some advise widespread cholesterol-lowering interventions ( LaRosa, 1995). However, treatment costs would be great and other CHD risk reducing interventions may be more cost-effective ( Avins, 1996). We espouse the conclusion of Garber, Littenberg, Sox, Wagner, and Gluck ( 1991) in their review of the cost and health consequences of cholesterol screening in the elderly:

If guidelines that were developed for the general adult population were strictly applied to the elderly, billions of dollars will be spent each year for an intervention whose effectiveness has not been tested. We can be more confident of the success of our efforts to improve and to prolong the lives of older Americans if we devote our resources to interventions whose effectiveness is not in doubt. (p. 1094)


ACKNOWLEDGMENTS

Supported in part by National Institutes of Health grants HL 46328 and HL 40962.

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