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High Cholesterol Board Index

Study: Different
rules for elderly?
by Delthia Ricks
Staff Writer

A low total cholesterol level,
a major objective in
preventing cardiovascular
disease, may be associated
with higher death rates in
people over 70, researchers
report in a study that flies in
the face of prevailing
medical wisdom.

Reporting tomorrow in the
British medical journal The
Lancet, scientists at the
University of Hawaii say not
only that older people with
low cholesterol die sooner
than their counterparts with
higher values, but also that
their study underscores
some of the unknowns about
human metabolism and

"We had seen these higher
mortality rates in older
people with low cholesterol
levels in several smaller
studies," said Dr. Irwin
Schatz, who led the
Hawaiian investigation. "We
decided to look at this in a
big way." Dr. Stanley Katz,
chief of cardiology at North
Shore University Hospital in
Manhasset, said that despite
the study's findings, the
results do not serve as a call
to the elderly to toss out
their cholesterol drugs or
add more fats to their diet.
medications, especially those
known as the statin drugs,
are widely prescribed to the
elderly with cardiovascular
conditions and can help
prevent heart attacks.

"These drugs stabilize
existing plaque, and a patient
taking a drug that stabilizes
the plaque will have a less
acute event in the case of a
heart attack," Katz said.

Just why a low total
cholesterol level is associated
with higher rates of death
among the elderly remains a
mystery. Schatz could only
speculate on this dramatic
metabolic reversal from
mid-life to old age.

"I really don't know the
answer to that. That's the
$64,000 question," he said.
Because study subjects had
either persistently high or
persistently low cholesterol
levels throughout life, he
speculates that those with
high cholesterol levels into
old age may be examples of
hardy survivors. These
people somehow escaped the
consequences of high
cholesterol in youth and
middle age.

Schatz and his colleagues
studied 3,500
Japanese-American men
who have been enrolled in
the Honolulu Heart Study,
which began in 1970.
(Schatz emphasized that
even though the study
focused on
Japanese-American men, the
results have applications to
all ethnicities and both
genders.) Each of the men
have had their total
cholesterol measured
regularly throughout the
study, providing a barometer
of how they fared from early
middle age until now. Study
subjects range in age from
71 to 93.

The men were divided into
four groups that ranged
from those with the lowest
total cholesterol levels to
those with the highest.
Results showed that men in
the first quartile, who
averaged a total cholesterol
level of 149 milligrams per
deciliter of blood, had a 28
percent higher mortality rate
than those in the next
quartile, whose average total
cholesterol was 178.

Those men who averaged a
total cholesterol of 232, a
level that would be
considered borderline-high in
middle age, had a 35 percent
lower death rate than their
counterparts with lower

Total cholesterol is the
combined values of
high-density lipoprotein and
low-density lipoprotein, the
so-called good and bad
forms of cholesterol that are
free-floating in blood.

Cholesterol is a soft, waxy
substance found most often
among fats in the
bloodstream. It is not itself a
fat, but is vital in maintaining
the integrity of cells and cell

Too much cholesterol, as
studies focusing on middle
age have shown, can be
deadly. It is key among the
goo that comprises plaque
and clogs arteries. For that
reason alone, doctors
cholesterol-reducing drugs
to keep potential heart
attacks and strokes at bay. A
desirable total cholesterol
level would fall under 200
milligrams per deciliter of
blood, cardiologists say.

Dr. Richard Stein, a
cardiologist and spokesman
for the American Heart
Association, said the Hawaii
study raises several flags,
and one is whether doctors
should treat elderly patients
as they do the middle aged.

"I think the issue of
cholesterol levels in the
elderly is still unclear.

And I think the aggressive
tendency among physicians
to bring down cholesterol to
very low levels may not have
a place in treating the elderly
patient," Stein said.

Other experts say the Hawaii
study points to the need for
more studies that focus on
the elderly.

Dr. Sylvia
Wassertheil-Smoller of the
Albert Einstein College of
Medicine in the Bronx, said
that without studies that zero
in on health matters of the
elderly, medicine will never
have a clear picture of
human aging. "What applies
to younger people may not
apply to older people.
Metabolism changes and
there are different nutritional
needs over time," she said.

Wassertheil-Smoller found in
a study last year that older
women who are somewhat
overweight and who have
high blood pressure are less
likely to die than their lithe
counterparts who have
comparable blood pressure

Dr. Richard Havlik, chief of
epidemiology at the National
Institute on Aging, applauds
the Hawaii study, saying the
growing number of analyses
on human aging will better
aid the treatment of disease.

"Once we get older we
inevitably develop diseases
and cholesterol metabolism
changes," Havlik said. "So
studies in this population
give us a picture of a
different part of the curve."

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