In middle-aged individuals, the causal relationship between
cholesterol, especially LDL cholesterol, and coronary heart disease
(CHD) [1], and the efficacy of statin therapy in reducing CHD risk,
are firmly established [1–5]. Fibrates have also been suggested to
reduce the incidence of nonfatal myocardial infarction [6]. In the
elderly, the evidence of an association between lipids and subsequent
CHD in observational studies is less clear [7–10], although
statins have been shown to reduce the risk of cardiovascular disease in this population [2,11]. Since the late ’90s, statin therapy has
been increasingly prescribed for the elderly population [12,13]. The
possible link between lipids and CHD risk in the elderly thus needs
to be revisited while separating those who receive lipid-lowering
treatment (LLT) from thosewhodo not, a study that has not yet been
undertaken in this population. The observation that lipids remain
predictive of CHD in spite of statin therapy (residual risk) would
raise the important question of whether or not more intensive
lipid management should be used in the elderly. In this light, using
data from the Three-City Study, a large French population-based
prospective study of community-dwelling elderly subjects [14], we
attempted to clarify the association between lipids, apolipoproteins
and CHD risk in the elderly, by separating individuals based on the
prescription of LLT and statin therapy in particular, in the primary
prevention setting.
In middle-aged individuals, the causal relationship betweencholesterol, especially LDL cholesterol, and coronary heart disease(CHD) [1], and the efficacy of statin therapy in reducing CHD risk,are firmly established [1–5]. Fibrates have also been suggested toreduce the incidence of nonfatal myocardial infarction [6]. In theelderly, the evidence of an association between lipids and subsequentCHD in observational studies is less clear [7–10], althoughstatins have been shown to reduce the risk of cardiovascular disease in this population [2,11]. Since the late ’90s, statin therapy hasbeen increasingly prescribed for the elderly population [12,13]. Thepossible link between lipids and CHD risk in the elderly thus needsto be revisited while separating those who receive lipid-loweringtreatment (LLT) from thosewhodo not, a study that has not yet beenundertaken in this population. The observation that lipids remainpredictive of CHD in spite of statin therapy (residual risk) wouldraise the important question of whether or not more intensivelipid management should be used in the elderly. In this light, usingdata from the Three-City Study, a large French population-basedprospective study of community-dwelling elderly subjects [14], weattempted to clarify the association between lipids, apolipoproteinsand CHD risk in the elderly, by separating individuals based on theprescription of LLT and statin therapy in particular, in the primaryprevention setting.
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