Q: I am 72 years old and have been treated with a medication to lower my cholesterol for the past five years. My wife is concerned because she saw a recent newspaper article stating that a high cholesterol level does not increase the risk of having a heart attack in people over the age of 70. Would you advise that I stop taking my medication?
A: Your specific question can not be answered without more information, such as the level of your cholesterol, the effectiveness of the medication in lowering your cholesterol, whether you had a previous heart attack or other evidence of coronary artery disease (CAD), the presence of risk factors for CAD (cigarette smoking, high blood pressure, diabetes, etc.), and the status of your general health. I can, however, discuss the general implications of the medical report that formed the basis for the newspaper article.
The report -- a study of 997 subjects from New Haven, Conn. published in the Journal of the American Medical Association -- concludes that in people over age 70 a high cholesterol has no effect on the risk of a heart attack, dying from CAD, or dying from any disease.
A problem with this report, and one that is especially pertinent to you, is any suggestion that the results apply to everyone older than 70. In fact, about half the subjects in the study were 80 or older. Also, although nearly 1,000 subjects may seem like a large number, they were followed for only four years and there were relatively few coronary events and deaths from coronary disease or other causes during this period.
These limitations of the study are important because the results conflict with several other studies, with more subjects and a longer follow-up period, which did show a high cholesterol level is associated with an increased risk of coronary artery disease in people over age 70.
It is also true that a high cholesterol becomes less of a risk at older ages than at younger ones. While multiple studies have now shown that lowering cholesterol levels has benefits for coronary artery disease in individuals under 65, no such study has been carried out in people over 70.
Cholesterol-lowering medications should be considered for men under 75 who have a cholesterol repeatedly greater than 250 and are otherwise in good health -- especially if they are at high risk for, or have a prior history of, coronary artery or other vascular disease.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.