Cholesterol in seniors

Among seniors, the high consumption of drugs or the coexistence of risk factors makes the fight against hypercholesterolemia a real headache. Anti-cholesterol treatment must be adapted on a case-by-case basis in the elderly, especially in the case of additional treatments.

Cardiovascular diseases are responsible for 180,000 deaths per year. By acting on the risk factors, it is possible to reduce this terrible scourge. Among them, excess cholesterol is the subject of all attention, but its management varies over the years.

Specificity of the elderly in the face of cholesterol 

Caring for an elderly person is not a matter of routine prescription . This age group has characteristics that can give doctors a hard time. In addition to the fact that she most often combines several risk factors , she is one of the biggest consumers of drugs. Elderly people take four times more drugs than younger adults.

And the phenomenon increases further with age, the 65-74 year olds take almost four drugs a day and the over 85s almost five. More than half of these products relate to the cardiovascular system  1 .

If he does not want to add a new drug to the long list of daily prescriptions, the doctor finds himself faced with a curious dilemma. Faced with hypercholesterolemia in an elderly person, he must encourage the person to act on all the risk factors: overweight, diet, smoking... But unfortunately, the habits of several decades are sometimes tenacious . Can we drastically change our lifestyle at 60 or 80? Not always easy!

Either way, the choice of treatment is on a case-by-case basis. " Beyond the simple criterion of age (in the strict sense), it is the physiological age of the patient as a whole that will guide our prescription according to the results of the analyzes , of course " explains Doctor Didier Méjean , general practitioner in Mennecy.

Cholesterol: controversies around octogenarians

As much as the role of hypercholesterolemia is considered harmful before the age of 70, its role beyond this age remains the subject of controversy . In octogenarians, the risk of cardiovascular disease seems less linked to excess cholesterol .

A study  2  on Mediterranean populations shows that very high cholesterol levels but also very low levels are linked to high mortality rates in people over 70 years of age. But some research goes even further. Published in 2001 in The Lancet  3 , a study carried out on more than 3,500 men aged 71 to 93, concluded that elderly people with very low cholesterol levels would have an increased risk of mortality. Although only concerning men of Asian origin, these results are astonishing. And the researchers are thus lost in conjecture to be able to explain the phenomenon. Three hypotheses are put forward:

• the persistence of low cholesterol levels over the long term could have a detrimental effect; 
• cholesterol could participate in the production of beneficial hormones; 
• individuals vulnerable to high cholesterol levels would die at ages below 70, while those reaching old age would benefit from protective factors.

" The population over 70 often combines several cardiovascular risk factors, but also sometimes multiple pathologies (hepatic, renal, etc.). In addition, it must take into account the potential side effects of prescribed drugs as well as their interference with other medications  Certain diseases, such as kidney failure or certain liver conditions, reduce the therapeutic possibilities of hypercholesterolemia, Alzheimer's disease can make treatment follow-up uncertain... "says Dr Méjean .

Finally, low cholesterol levels can become an indicator of poor health and reflect malnutrition, which is very common in the elderly .

From the age of 50, the importance of cholesterol prevention 

Cardiovascular risk increases with age and becomes more of a concern in the fifties . Women are generally spared until age 55 and men until age 45, but these averages only partially reflect the reality of terrible complications like heart attack or stroke.

Thus, the monitoring of cholesterol levels becomes an essential concern in young seniors. Prevention is better than cure ! To avoid having a surprise on his next analysis sheet, a few lifestyle tips will help you keep your arteries healthy. A balanced diet - with particular distrust of animal fats (milk, cheese, butter, fresh cream, eggs, meats, etc.) and a little exercise generally helps keep cholesterol within reasonable proportions .

When a 50-year-old patient suffers from hypercholesterolemia, the same weapons used in prevention can be used as treatment. A specific diet and some physical activity in case of overweight are the first weapons against this natural fat. The doctor will adapt these two components to the patient's age. No question of registering a 65-year-old sedentary person for the next Paris marathon! If the analyzes do not normalize after three months or if the person has a high cardiovascular risk from the outset, the drugs can be added. Of the lipid- lowering drugs , statins and fibrates are the most commonly used.

Cholesterol management after 65

When updating the recommendations for the management of cholesterol, the Haute Autorité de Santé specifies that the treatment of hypercholesterolemia in the elderly thus requires a certain number of precautions. In summary :

Whatever the age, dietary advice (Mediterranean-type diet) and physical activity should be promoted.

In primary prevention (before the occurrence of a proven cardiovascular problem):

• in subjects aged 65 to 80 , initiation of statin therapy is recommended if necessary, as in younger patients;
• in subjects over 80 years of age , in the absence of data, the initiation of treatment is not recommended. However, certain criteria such as the accumulation of RCV factors and the absence of serious pathology reducing life expectancy allow the continuation of treatment when it is well tolerated;

It is recommended to have a discussion with these patients who could be treated for primary prevention about the risks and benefits of statin treatment so that they can make a decision about taking these drugs in the long term.

In secondary prevention (after the occurrence of a cardiovascular problem):

The general rules of care apply except for major fragility or limited life expectancy. Management is based on a change in lifestyle (dietary advice, physical activity, fight against a sedentary lifestyle and other cardiovascular risk factors such as smoking, etc.) associated with a lipid-lowering drug (most often a statin).

Beyond the age of 80, the High Authority for Health judges that it is not recommended to give restrictive dietary advice because it promotes the risk of undernutrition. Finally, do not resort to so-called natural treatments (red yeast rice or phytosterols) without talking to your doctor.