This chapter will introduce issues related to management of lipid disorders in older patients to reduce the risk of atherosclerosis and cardiovascular disease (CVD). Because lipid metabolism and regulation do not vary greatly between younger and older people, age-related influences on cardiovascular risk and lipoprotein-mediated disease processes will be our central theme. In addition, aspects of appropriate pharmacotherapy and support of treatment adherence will balance out the overall review.
AGE AND CARDIOVASCULAR RISK
Clinicians typically approach the task of assessing cardiovascular risk by focusing on patient age as an obvious “nonmodifiable risk factor.” The Framingham risk score estimates 10-year absolute risk for CVD events and age contributes enormously to the end result, given that indeed age is the greatest contributor to absolute cardiovascular risk. This may be related to the multiple observations that have concluded atherosclerosis as a process that begins early in life. Advanced age reflects an increased duration of exposure to various risk factors and an accumulation of coronary disease burden. The Framingham Risk Score is less robust in the elderly (age >70 years) as this group has already had their “age-based” exposure. A comparison of the risk factor counting method as outlined in the National Cholesterol Education Program Guidelines to a multivariate analysis demonstrated that these guidelines underestimate risk among more than 5 million persons with fewer than two risk factors. Compared to individuals whose classification was unchanged, those misclassified as low risk were older and more likely to be male.