High cholesterol after age 70

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A recent report from researchers at Yale University challenges the notion that low cholesterol readings are good ones, regardless of a person's age. The study found that unlike younger people, those who are more than 70 years old do not appear to incur increased risk of heart attack, angina, or death from any cause by having either high total cholesterol nor low HDL-cholesterol (the good one).

In 1988 the Yale investigators collected blood samples for cholesterol analysis from 610 women and 387 men between the ages of 70 and 104. The average age was 79. They also interviewed each participant, taking health histories and giving special emphasis to heart attack, chest pain, and hospitalizations for coronary heart disease. In 1992 they checked the death records and noted the cause of death for each participant who died during the period.

They then compared the information in each person's records with his or her cholesterol readings. They found that 32% of the women, but only 16% of the men, had total cholesterol levels greater than 240 mg/dl, and that 9% of the women and 26% of the men had low HDL levels. However, the difference appeared to be meaningless; there was no significant association between either total cholesterol or HDL levels and the occurrence of heart attacks or deaths in either group.

When only women were considered the results were even more surprising. Those who survived the longest had cholesterol levels greater than 240 mg/dL, followed by a group with levels between 200 and 240 mg/dL. Those who had the lowest cholesterol readings (below 200 mg/dL) also had the lowest survival rates.

Although the results of larger studies are needed before new policies on managing cholesterol are written, some experts are advising that doctors stop performing cholesterol tests or treating high cholesterol in people in their late 70s. They contend that cholesterol-lowering drugs are more likely to have toxic effects or to interact with other drugs in older people.

However, the study's findings shouldn't be extended to people who are younger than 70 or interpreted as license to overindulge in dietary fats. Restricting fat to 30% of calories is still a good policy because doing so promotes the retention of lean body mass, decreases the likelihood of obesity, and tips the dietary balance toward fruits, vegetables, and grains-all of which substantially reduce a variety of health risks.

The report was published in the November 2, 1994, issue of the Journal of the American Medical Association.

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