Dyslipidemia and Coronary Artery Disease in the Elderly

Age-associated changes in human carotid atherosclerotic plaques

Little is known about changes in carotid plaque morphology during aging and the possible impact on cardiovascular events. Only few studies addressed so far age-related modifications within atherosclerotic lesions. Therefore, in this work we endeavored to summarize the current knowledge about changing of plaque composition in elderly. The data from hitherto existing studies confirm that atherosclerotic plaques undergo distinct alternations with advanced age. However, the results are often ambiguous and the changes do not seem to be as disastrous as expected. Interestingly, none of the studies could definitely evidence increased plaque vulnerability with advanced age. Nevertheless, based on the previous work showing decrease in elastin fibers, fibroatheroma, SMCs, overall cellularity and increase in the area of lipid core, hemorrhage, and calcification, the plaque morphology appears to transform toward unstable plaques. Otherwise, even if inflammatory cells often accumulate in plaques of younger patients, their amount is reduced in the older age and so far no clear association has been observed between thin fibrous cap and aging. Thus, the accurate contribution of age-related changes in plaque morphology to cardiovascular events has yet to be elucidated. KEY MESSAGES Composition of carotid atherosclerotic lesions changes during aging. These alternations are however, just moderate and depend upon additional variables, such as life style, accompanying disease, genetics, and other factors that have yet to be determined. Based on the current data, the age-associated plaque morphology seems to transform toward vulnerable plaques. However, the changes do not seem to be as disastrous as expected.

Health status, blood and anthropometrical indices from Greek old and nonagenarian subjects

As the elderly population is increasing rapidly, there is a lot of scientific interest in clarifying the differential life-style, genetic, biochemical and molecular factors contributing to mortality or exceptional longevity. Within the framework of the ZINCAGE project, 249 old (60-85 years) and nonagenarian Greek subjects (>/=85 years old) were recruited and anthropometrical, blood and biochemical indices as well as blood pressure measurements were obtained. Based upon the inclusion criteria, 214 of them were characterized as healthy (136 female, 78 male), while those characterized as non-healthy were excluded from the statistical analysis. The findings indicated an 88.4% prevalence of overweight and obesity in elderly (91.2% in women, 83.3% in men), while a significant decrease in body mass index with age was recorded. Hypercholesterolemia was observed in 75.3% of elderly women and in 69.2% of men. Erythrocyte sedimentation rate value was increased in 27.6% of all healthy elderly, while zinc deficiency was observed in 18.7% of elderly. Over 85.0% of all healthy elderly were within normal range for all other hematological analysis. Blood analysis confirmed the good health status of the elderly recruited as healthy, except for the high prevalence of obesity and hypercholesterolemia.

Lipid Management and the Elderly

Advancing age is an independent risk factor for the development of coronary heart disease. However, the significance of hypercholesterolemia as a cardiovascular risk factor in the elderly, has been widely debated. While no large-scale, randomized clinical trial has been conducted to evaluate cholesterol lowering solely in the elderly, evidence from older subgroups in several intervention trials supports the efficacy of lowering elevated low-density lipoprotein cholesterol for reducing cardiovascular risk in the elderly. Furthermore, although the relative risk of hyper-cholesterolemia for coronary heart disease incidence may be attenuated with advancing age, the population-wide impact of treating elevated cholesterol levels in the elderly would be large, due to the high frequency of coronary heart disease in the elderly. This article reviews key issues in the management of hyper-cholesterolemia with respect to coronary heart disease risk reduction in the elderly.

Controversies in the Treatment of Hypercholesterolemia in the Elderly: Who Should Be Treated and How?

High levels of low-density lipoprotein cholesterol may contribute to the development of coronary heart disease in the absence of other risk factors. This paper reviews major cholesterol prevention trials since 1994 concerning possible beneficial results of lowering cholesterol in persons over 65 years of age.

Hypercholesterolemia and coronary heart disease in the elderly: a meta-analysis

PURPOSE

To determine whether hypercholesterolemia is an independent risk factor for CHD morbidity and mortality in persons aged 65 years and above, and to quantify the magnitude of the association, if any, using data from follow-up studies.

METHODS

A MEDLINE search of all published studies that evaluated the association between high cholesterol levels and CHD in persons aged 65 years and above, and the relevant articles referenced in these studies, were used as sources of selected articles.

RESULTS

In men aged 65 years and above who were followed from middle age, the RR for CHD incidence associated with 1.0 mmol/L increase in total cholesterol was 1.28 (CI: 1.17-1.39). The RR for CHD mortality associated with a similar increase in total cholesterol was 1.22 (CI: 1.18-1.27). In elderly men followed from age 65 and above, the RR was 1.24 (CI: 1.1-1.37) for CHD incidence, and 1.22(CI: 1.15-1.28) for CHD mortality. In elderly women followed after age 65, the association between total cholesterol and CHD mortality was not significant. For men aged 80 years and above at entry, total cholesterol showed an inverse relationship with all-cause mortality.

CONCLUSION

Serum total cholesterol shows a positive association with CHD morbidity and mortality in men aged 65 years and above. This may, however, not hold true for persons aged 80 years and above.

Cardiac rehabilitation and preventive cardiology in the elderly

This article reviews data demonstrating the benefits of cardiac rehabilitation and exercise training programs in the elderly. Other risk factor interventions, including cessation of smoking, treatment of diabetes, and lipid therapy, are very beneficial for the elderly with coronary heart disease or strong risk of coronary heart disease. Also briefly reviewed are current data suggesting the benefits of antioxidant vitamins, and folic acid to reduce levels of homocysteine for the primary and secondary prevention of coronary heart disease in the elderly.

Influence of age on the safety, tolerability, and pharmacokinetics of the novel HMG-CoA reductase inhibitor cerivastatin in healthy male volunteers

The safety, tolerability, and pharmacokinetics of cerivastatin, a novel, synthetic, potent, and highly selective HMG-CoA reductase inhibitor, were studied in 48 young and elderly male volunteers in a randomized, double-blind, placebo-controlled study. Eight men ranging from 18 to 38 years of age (young) and 15 men ranging from 65 to 78 years of age (elderly) received 0.1-mg cerivastatin tablets daily for 7 days. The remaining subjects (8 young and 17 elderly) received matching placebo tablets. Cerivastatin was well tolerated in elderly and young subjects. Adverse events were mild and occurred less frequently in the participants receiving cerivastatin than in those receiving placebo. In those participants given cerivastatin, the incidence of adverse events was similar for both age groups (4 of 8 young subjects and 8 of 15 elderly subjects). Transient and mild elevations in creatine kinase and transaminase levels were evenly distributed across the cerivastatin and placebo groups. Pharmacokinetic parameters, including area under the concentration curve (AUC), peak plasma concentration (Cmax), time to Cmax (tmax), and elimination half-life (t1/2), were similar between the two age groups. The mean elimination t1/2 for both groups was approximately 4 hours. These results indicate that cerivastatin is well tolerated in elderly male volunteers at a dosage of 0.1 mg/day. Further, the pharmacokinetics of cerivastatin are not altered as a consequence of age. Dose adjustment is therefore not required in elderly men.

Physical activity and cardiovascular health in the elderly

People over the age of 65 constitute a growing proportion of the world population both in western and in developing countries. A unique feature of this group is the high prevalence of cardiovascular diseases, which negatively affect its quality of life as well as its life expectancy. Among the interventions able to reduce the health burden of cardiovascular diseases is physical activity. The benefits of physical activity have been demonstrated both in healthy and chronically ill elderly subjects, while the risks have been found to be modest. Physicians should recommend moderate-intensity physical activity to sedentary older subjects, who are still the majority within the elderly population.