Wilbert S. Aronow, MD, CMD
Department of Medicine,
New York, Medical College
Department of Geriatrics and Adult Development,
Mount Sinai School of Medicine,
New York, NY, USA.

There are conflicting data regarding the association of abnormal serum lipids with stroke in older men and women.^1-4 Despite these conflicting data, simvastatin and pravastatin have been demonstrated to cause a significant reduction in the incidence of stroke in older men and women with coronary artery disease (CAD) in the Scandinavian Simvastatin Survival Study,⁵ in the Cholesterol and Recurrent Events Trial,^6-10 and in the Long-Term Intervention With Pravastatin in Ischaemic Disease Study (Table 1).^11,12

Scandinavian Simvastatin Survival Study
The Scandinavian Simvastatin Survival Study was a prospective double-blind, placebo-controlled trial which randomized 4,444 men and women (2,282 of whom were 60 to 70 years of age) with CAD and hypercholesterolemia to treatment with either 20 mg to 40 mg of simvastatin daily or placebo.⁵ Simvastatin significantly reduced serum total cholesterol by 25% from 261 mg/dL to 196 mg/dL, serum low-density lipoprotein (LDL) cholesterol by 35% from 188 mg/dL to 122 mg/dL, and serum triglycerides by 10% from 133 mg/dL to 120 mg/dL. It significantly increased serum high-density lipoprotein (HDL) cholesterol by 8% from 48 mg/dL to 52 mg/dL.⁵ At 5.

Jocalyn P. Clark, MSc

The link between hyperlipidemia (elevated cholesterol levels) and coronary artery disease (CAD) is well established in adult populations, for which there are a variety of preventative and treatment strategies. Research has not typically included older patients in large numbers, therefore extrapolation of evidence to the care of older people can be difficult. Controversy exists about both diet and drug options for cholesterol treatment in the elderly, especially among those 75 years and older, suggesting that careful consideration and caution is required in determining 'whom' and 'how' to treat. Since the majority of cardiovascular disease occurs above the age of 65, especially in women, treatment of hyperlipidemia in the elderly is an important challenge.

In considering treatment options for hyperlipidemia in elderly patients, a recent review in Drugs and Aging suggests that target low density lipoprotein cholesterol (LDL-C) levels should be <3.2 mmol/L, with total cholesterol levels aiming to be <5.2 mmol/L.