2004, Number 4
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Arch Cardiol Mex 2004; 74 (4)
Dyslipidemia in the Elderly
Lasses y OLA, Torres GJL, Salazar E
Language: Spanish
References: 55
Page: 315-326
PDF size: 104.03 Kb.
ABSTRACT
Age is an independent and unmodifiable risk factor for coronary atherosclerosis. In Mexico, coronary heart disease is responsible for 50 % of the deaths for those older than 65 years of age. Aging produces major differences in the presentation, diagnosis, prognosis, and response to therapy in coronary heart disease. The goal of treatment is the prolongation of survival and the improvement of the quality of life. However, in the elderly, the aim of therapy should focus on attaining a meaningful quality of life thus allowing them to be functionally independent. Clinical trials demonstrate conclusively that lowering serum cholesterol levels will reduce the incidence of coronary heart disease irrespective of age. Dietary advise and life-style modifications are the first-line approach in the elderly. When these measures are insufficient to achieve target lipid reductions, statins are the drug of choice. Fibrates may be indicated if triglycerides are high and C-HDL is low. Given the grater coronary risk of older population, the absolute benefit will be greater in the elderly.
REFERENCES
United Nations: 1998. Revision of the World Population. Estimates and Projections.
Batchelor WB, Jollis JG, Friesinger GC: The challenge of health care delivery to the elderly patient with cardiovascular disease. Demographic, epidemiologic, physical, and health policy implications. Cardiology Clinics 1999; 17: 1-15.
Los desafíos demográficos de México en el nuevo milenio. En: La Situación Demográfica de México. Consejo Nacional de Población. 1998: 19-26.
Zimetbaum P, Frishman WH, Ooi WL, Derman MP, Aronson M, Gidez LI, et al: Plasma lipids and lipoproteins and the incidence of cardiovascular disease in the very elderly. The Bronx Aging Study. Arterioscler Thromb 1992; 12: 416-423.
Principales resultados de la estadística sobre mortalidad en México, 1998. Salud Pública Méx 2000; 42: 155-159.
Konu V: Myocardial infarction in the elderly. A clinical and epidemiological study with a one-year follow-up. Acta Med Scan 1977; Suppl 604: 1-68.
Friesinger GC, Ryan TJ: Coronary heart disease. Stable and unstable syndromes. Cardiology Clinics 1999; 17: 93-122.
Mehta RH, Rathore SS; Radford MJ, Wang Y, Krumholz HM: Acute Myocardial Infarction in the elderly: Differences by age. J Am Coll Cardiol 2001; 38: 736-741.
Weaver DW, Litwin PE, Martín JS, Kudenchuk PJ, Maynard CD, Eisenberg MS et al: The MITI project Group. Effect of age on use of thrombolytic therapy and mortality in acute myocardial infarction. J Am Coll Cardiol 1991; 18: 657-662.
Ettinger WH, Wahl PW, Kuller LH, Bus TL, Tracy RP, Manolio TA et al: Lipoprotein lipids in older people. Results from the Cardiovascular Health Study. Circulation 1992; 86: 858-869.
Posadas-Romero C, Tapia-Conyer R, Lerman-Garber I, Zamora-González J, Cardoso-Zaldaña G, Salvatierra-Izaba B, Sepúlveda-Amor JA: Cholesterol levels and prevalence of hipercholesterolemia in a Mexican adult population. Atherosclerosis 1995; 118: 275-284.
Sienra-Pérez JC: Tratamiento de las dislipidemias en ancianos. En: Posadas-Romero C. Dislipidemias y Aterosclerosis. México. Ed. Interamericana- McGraw-Hill, 1995: 255-267.
Encuesta Nacional de Enfermedades Crónicas. México. Dirección general de Epidemiología. Secretaría de Salud. Tercera Edición. Julio 1996.
Aguilar-Salinas CA, Lerman-Garber I, Pérez J, Villa AR, Llaca-Martínez C, Cervantes-Turrubiatez L, et al. Lipids, Apoprotein B, and associated coronary risk factors in urban and rural older Mexican populations. Metabolism 2001; 50: 311-318.
Sempos CT, Cleeman JI, Carrol MD: Prevalence of high blood cholesterol among U.S. adults: An update based on guidelines from the Second Report of the National Cholesterol Education Program Adult Treatment Panel. JAMA 1993; 269: 3009-3014.
Summary of the Second Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult treatment panel II). JAMA 1993; 269: 3015-3023.
Rubin SM, Sidney S, Black DM: High blood cholesterol in elderly men and the excess risk for coronary heart disease. Ann Intern Med 1990; 113: 916-920.
Harris T, Cook EF, Goldman L: Proportional hazards analysis of risk factors for coronary heart disease in individuals aged 65 or older: The Framingham Heart Study. J Am Geriatr Soc 1988; 36: 1023-1028.
Weverling-Rijinsburger AW, Blauw GJ, Lagaay AM: Total cholesterol and risk of mortality in the oldest old. Lancet 1997; 350: 1119-1123.
Schatz IJ, Masaki K, Yano K, Chen R, Rodríguez BL, Curb D: Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study. Lancet 2001; 358: 351-355.
Corti MC, Guralnik JM, Salive ME, Harris T, Field TS, Wallace RB, et al: HDL Cholesterol predicts coronary heart disease mortality in older persons. JAMA 1995; 274: 539-544.
Corti MC, Guralnik JM, Salive ME, Harris T, Ferrucci L, Glynn RJ, et al: Clarifying the direct relation between total cholesterol levels and death from coronary heart disease in older persons. Ann Intern Med 1997; 126: 753-760.
Weverling-Rijnsburger AWE, Iris Jonkers IJAM, van Exel E, Gussekloo J, Westendorp RGJ: High-density vs low-density lipoprotein cholesterol as risk factor for coronary artery disease and stroke in old age. Arch Intern Med 2003; 163: 1549-1554.
National Cholesterol Education Program 1993: Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. National Institute of Health. Circulation 1994; 89: 1336-1345.
Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-2497.
De Lorgerill M, Salen P, Martín JL, Monjaud I, Delaye J, Mamelle N: Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: Final report of the Lyon Diet Heart Study. Circulation 1999; 99: 779-785.
Carlson CM, Carnes M, McBride PE, Stein JH: Managing Dyslipidemia in Older Adults. J Am Geriatr Soc 1999; 47(12): 1465-1468.
Smith SC, Blair SN, Criqui MH, Fletcher GF, Fuster V, Gersh BJ, et al: Preventing heart attack and death in patients with coronary disease. Circulation 1995; 92: 2-4.
What are the important components of a heart-healthy diet?. General Guidelines Cholesterol, Other Lipids, and Lipoproteins; Angina and Coronary Artery Disease and High Blood Pressure. March 2000. Disponible en http://www. healthandage.com/Home/gm%3D20%21gsq% 3Ddiet%21gid6=4302
Russel RM, Saltzman E, Rasmussen H: Comparison of diet claims. Disponible en http://www. healthandage.com/Home/gm%3D20%21gsq% 3Ddiet%21gid2=355
Russel RM, Lichtensten AH: Guidelines for dietary treatment. Current issues related to diet and cardiovascular disease. Disponible en: http://www.healthandage.com/html/well_connected/pdf/doc23.pdf
De Waart FG, Moser U, Kok FJ: Vitamin E supplementation in the elderly lowers the oxidation rate of linoleic acid in LDL. Atheroesclerosis 1997; 133: 255-263.
Carr AC, Zhu BZ, Frei B. Potential antiatherogenic mechanics of ascorbate (vitamin C) and alfa-tocopherol (vitamin E). Cir Res 2000; 87: 349-354.
Palace VP, Hill MF, Farahmand F, Singal PK: Mobilization of antioxidant vitamin pools and hemodynamic function after myocardial infarction. Circulation 1999; 99: 121-126.
Yusuf S, Dagenais G, Poque J, Bosch J, Sleight P: Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000; 342: 154-160.
Heart Protection Study Collaborative Group: MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20,536 high-risk individuals: a randomized placebo-controlled trial. Lancet 2002; 360: 23-33.
Lonn EM: The role of colesterol management in coronary artery disease. Evidence-based Cardiovascular Medicine 2000; 4: 59-61.
Grundy SM: The role of cholesterol management in coronary disease risk reduction in elderly patients. Endocrinology and Metabolism Clinics 1998; 27: 668-669.
Philip A. Ades, M: Cardiac Rehabilitation and secondary prevention of coronary heart disease. N Engl J Med 2001; 345: 892-902.
Blair SN, Kohl HW, Barlow CE: Physical activity, physical fitness, and all-cause mortality in woman: do woman need to be active? J Am Coll Nutr 1993; 12: 368-371.
Alexander NB, Galecki AT, Grenier ML: Task-specific resistance training to improve the ability of activities of daily living-impaired older adults to rise from a bed and from a chair. J Am Geriatr Soc 2002; 49: 1418-1427.
Dubach P: Exercise training in chronic heart failure: why, when and how. Swiss Med Wkly -8-Sep-2001; 131(35-36): 510-4.
Duncan JJ, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al: Physical Activity and Public Health: A Recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273: 402-407.
US Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.
LaRosa JC, Applegate W, Crouse III JR: Cholesterol reduction in seniors program. Pilot study. (CRISP). Arch Intern Med 1994; 154: 529-539.
Gould AL, Rossouw JE, Santanello NC, Heyse JF, Furberg CD: Cholesterol reduction yields clinical benefit. Impact of statin trials. Circulation 1998; 97: 946-952.
Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, Macfarlane PW, et al: Prevention of coronary disease with pravastatin in men with hypercholesterolemia. West of Scotland coronary prevention study group. (WOSCOPS). N Engl J Med 1995; 333: 1301-1307.
Downs JR, Clearfield M, Weis S, Whitney E, Shapiro D, Beere P, et al: Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: Results of AFCAPS/TexCAPS. JAMA 1998; 279: 1615-1622.
Scandinavian Simvastatin Survival Study Group: Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: 4S. Lancet 1994; 344: 1383-1389.
Sacks FM, Pfeffer MA, Moye LA: The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. (CARE). N Engl J Med 1996; 335: 1001-1009.
The Long-Term Intervention with Pravastatin in ischemic Disease (LIPID) Study Group: Prevention of cardiovascular events and death with pravastatin in patients with coronary heart diseases and a broad range of initial cholesterol values. N Engl J Med 1998; 339: 1349-1357.
Heart Protection Study Collaborative Group: MRC / BHF Heart Protection Study of cholesterol lowering with simvastatin 20,536 high-risk individuals: a randomized placebo-controlled trial. Lancet 2002; 360: 7-22.
Shepherd J, Blaw GJ, Murphy MB, Bollen El, Buckley BM, Cobbe SM, et al: Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomized controlled trial. Lancet 2002; 360: 1623-1630.
Carlson LA, Rosenhamer G: Reduction of mortality in the Stockholm ischaemic heart disease secondary prevention study by combined treatment with clofibrate and nicotinic acid. Acta Med Scand 1988; 223: 405-418.
Rubins HB, Robins SJ, Collins D, Fye CL, Anderson JW, Elam MB, Faas FH, et al: Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. The Veterans affairs cooperative studies program. High-density lipoprotein cholesterol intervention trial (VA-HIT). N Engl J Med 1999; 341: 410-418.