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Where's the Beef?

 
Cholesterol After Age 65

For the past two decades, the public has been bombarded with information about cholesterol. Everywhere we turn, there are messages telling us to lower our cholesterol level.

The American Heart Association has issued the following classifications:

Total Cholesterol Classification
Less than 200 Desirable
200-239 Borderline
More than 240 High

Unfortunately, the above classification does not specify different age groups in the population. Nor does it take into account where cholesterol levels fit in the scheme of other risk factors for heart disease.

The major risk factors for developing heart disease are as follows:

  1. Family history of early heart disease
  2. Tobacco use
  3. Hypertension
  4. Diabetes Mellitus
  5. Elevated cholesterol
  6. Severe obesity

Obviously you cannot change your family history, but it is never too late to stop smoking. Studies have shown that the benefit from smoking cessation in reducing heart disease can be gained at any age! High blood pressure is also an important risk factor for the development of heart disease. In younger adults, the benefits of treatment appear clear. More recent studies have also demonstrated the benefit of treating high blood pressure in older adults.

man with mouth open wearing red shirtThis brings us to the topic of this article. Literally, “where’s the beef” when it comes to cholesterol levels in adults over the age of 65? An elevated cholesterol level is clearly associated with an increased risk for developing heart disease in middle-aged men. Unfortunately, even in this population, while it has been shown that lowering one’s cholesterol level will lower the risk of heart disease, it has not been shown to increase the lifespan.

What does this mean to the person over the age of 65? Studies that have looked at the effect of cholesterol levels on people between the ages of 65 to 80 have had mixed findings. While there still appears to be some correlation between cholesterol level and heart disease in older persons, this correlation declines up until the age of 80. Beyond the age of 80, there is much less evidence that an elevated serum cholesterol is a risk for heart disease.

Unfortunately, as a geriatrician, I have seen an elevated cholesterol in older patients become the impetus for the development of malnutrition. One patient was actually close to death because she had limited her diet out of fear of elevated cholesterol levels. Malnutrition is probably a greater concern for adults over the age of 80 than cholesterol levels!

Of course, there are exceptions to every rule. An exception to what I have stated would be someone with a previously known history of heart disease associated with an elevated cholesterol level. Such patients should seek advice from their physician regarding reducing their cholesterol level.

The point of this article is that a healthy older individual with no risk factors for heart disease need not be concerned about their cholesterol level. I am not saying that, because you’re 80, there is no point in worrying about your cholesterol level because life is short already--quite the contrary! Rather, because you’re 80 and you’ve never had problems with heart disease, your body probably doesn’t care about your cholesterol level! Those between the ages of 65 and 80 with no major risk factors for heart disease need to balance the potential effects on their nutritional status and general well being with the marginal benefit that lowering their cholesterol may achieve. Those with other risk factors for developing heart disease should always be evaluated individually by their physician.

 

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