Wilbert S. Aronow, MD, Department of Medicine, Cardiology, Geriatrics, and Pulmonary/Critical Care Divisions, New York Medical College, Valhalla, NY, USA.

Randomized, double-blind, placebo-controlled studies and observational studies have demonstrated that statins reduce mortality and major cardiovascular events among high-risk older adults with hypercholesterolemia. The Heart Protection Study showed that statins reduced mortality and major cardiovascular events in high-risk persons regardless of the initial level of serum lipids, age, or gender. The updated National Cholesterol Education Program (NCEP) III guidelines state that among very high-risk patients a serum LDL cholesterol level of less than 70 mg/dl (1.8 mmol/l) is a reasonable clinical strategy, regardless of age. When a high-risk person has hypertriglyceridemia or low serum HDL cholesterol, consideration can be given to combining a fibrate or nicotinic acid with an LDL cholesterol-lowering drug. For moderately high-risk persons (having two or more risk factors and a 10-year risk for CHD of 10-20%) the serum LDL cholesterol should be reduced to less than 100 mg/dl (2.6 mmol/l). When LDL cholesterol-lowering drug therapy is used to treat high-risk persons or moderately high-risk persons, the serum LDL cholesterol should be reduced at least 30-40%.
Key words: lipids, statins, lipid-lowering drugs, coronary heart disease, atherosclerotic vascular disease, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides.