A E Fletcher1, C J Bulpitt. 1. Epidemiology Research Unit, Royal Postgraduate Medical School, London, UK.
Abstract
BACKGROUND: Cardiovascular disease is the leading cause of death in the elderly in industrialized societies. However, in the elderly, unlike middle-aged subjects, little attention has been paid to strategies for reducing morbidity and mortality from this disease. OBJECTIVES: To review studies of risk factors for cardiovascular diseases in the elderly and the evidence, if any, of risk factor modification. FINDINGS: Overall, the evidence suggests that the established risk factors for cardiovascular disease in middle-aged subjects persist into old age. Several studies have shown that serum cholesterol is positively associated with a risk of coronary heart disease. In the very elderly, U-shaped distributions have been reported for the relationship between cholesterol and total mortality, probably as a result of other confounding factors. At present there is little experimental evidence of benefits from lowering cholesterol in the elderly. In contrast, several randomly allocated, placebo-controlled trials have established the benefits of blood pressure reduction (systolic or diastolic) up to the age of 84 years. A high blood pressure in the very old probably remains a risk factor, but prospective studies have reported non-linear relationships. Smoking has been reported to be a risk factor in the elderly in some, but not all studies. CONCLUSIONS: At present, only the treatment of high blood pressure can be definitively recommended in the elderly. The effects of both dietary and pharmacological modification of cholesterol need to be investigated.
BACKGROUND:Cardiovascular disease is the leading cause of death in the elderly in industrialized societies. However, in the elderly, unlike middle-aged subjects, little attention has been paid to strategies for reducing morbidity and mortality from this disease. OBJECTIVES: To review studies of risk factors for cardiovascular diseases in the elderly and the evidence, if any, of risk factor modification. FINDINGS: Overall, the evidence suggests that the established risk factors for cardiovascular disease in middle-aged subjects persist into old age. Several studies have shown that serum cholesterol is positively associated with a risk of coronary heart disease. In the very elderly, U-shaped distributions have been reported for the relationship between cholesterol and total mortality, probably as a result of other confounding factors. At present there is little experimental evidence of benefits from lowering cholesterol in the elderly. In contrast, several randomly allocated, placebo-controlled trials have established the benefits of blood pressure reduction (systolic or diastolic) up to the age of 84 years. A high blood pressure in the very old probably remains a risk factor, but prospective studies have reported non-linear relationships. Smoking has been reported to be a risk factor in the elderly in some, but not all studies. CONCLUSIONS: At present, only the treatment of high blood pressure can be definitively recommended in the elderly. The effects of both dietary and pharmacological modification of cholesterol need to be investigated.
Authors: J M López-Carmona; R Rodríguez-Moctezuma; C Munguía-Miranda; J L Hernández-Santiago; E Casas de la Torre Journal: Aten Primaria Date: 2000-11-15 Impact factor: 1.137