Is it advantageous to lower cholesterol in the elderly hypertensive?

Hypertension is often associated with other risk factors for cardiovascular disease, including elevated levels of cholesterol, and casual systolic hypertension is a very prevalent finding in the elderly (50% of women over the age of 80 have casual systolic blood pressures > or = 160 mmHg). Total cholesterol levels steadily increase with age from 20 to 65, following which they decrease slightly in men and tend to plateau in women. Elevated cholesterol levels are not uncommon in the elderly (61% of women aged between 65 and 74 have total cholesterol levels over 6.2 mmol/L [240 mg/dL]). From the data available, it is reasonable to conclude that after the age of 65, increased blood lipids, although still a risk factor for coronary heart disease (CHD), become less pronounced as risk factors and that by 75 years of age their predictive value has disappeared. Indeed, in the very elderly, there is evidence to suggest that high total cholesterol is associated with longevity. In elderly hypertensives with elevated serum cholesterol, differing risks have been reported. The European Working Party on Hypertension in the Elderly (EWPHE) trial suggested a negative relationship between cholesterol and mortality, while the Systolic Hypertension in the Elderly Program (SHEP) trial suggested a positive relationship. With regards to intervention, it is well documented that antihypertensive treatment in elderly hypertensives up to the age of 80 who have blood pressures over 160 mmHg systolic is associated with significant reductions in stroke and cardiovascular events. The efficacy of dietary modification in reducing cholesterol in the elderly has been supported by some studies but not by all. Three major intervention trails using statins have shown that in elderly patients up to the age of 70-75 who have established CHD, lipid-lowering therapy can be of benefit. The experience from these and other trials suggests that statins are generally well tolerated in the elderly. It is difficult and premature to extrapolate these results to elderly patients who have hypertension and raised cholesterol levels without established CHD. Further trials are required before routinely suggesting it is advantageous to lower cholesterol in an elderly hypertensive who does not have pre-existing evidence of CHD. It is possible that large numbers may prove to require treatment.