Management of hyperlipidemia in the elderly population: an evidence-based approach.

Coronary heart disease (CHD) is the leading cause of morbidity and mortality in patients more than 65 years old. Within this population, elevated cholesterol levels are prevalent and associated with increased risk of CHD. Despite increasing emphasis on lipid-lowering treatment in the elderly population, questions remain regarding secondary and primary prevention of CHD. According to current clinical trial evidence, lipid-lowering therapy, specifically with HMG-CoA-reductase inhibitors, can reduce CHD morbidity and mortality without increased adverse effects in the elderly population. Lipid-lowering treatment should be considered for patients aged 65 to 75 years with a history of CHD or who are at moderate to high risk for CHD. Estrogen replacement therapy (ERT), which has also been shown to lower cholesterol levels, raises special considerations for postmenopausal women. However, recent findings suggest that postmenopausal women with a history of CHD should not be given estrogen solely for secondary prevention of CHD events.