Is it advantageous to lower cholesterol in the elderly hypertensive?
Is it advantageous to lower cholesterol in the elderly hypertensive?
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DOI：
10.1023/a:1007812232328
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发表时间：
2000-08-01
影响因子：
3.4
通讯作者：
Bulpitt, C
中科院分区：
文献类型：
--
作者：
Beckett, N;Nunes, M;Bulpitt, C
高血压通常与心血管疾病的其他风险因素相关，包括胆固醇水平升高，并且偶发性收缩期高血压在老年人中非常普遍（50%的80岁以上女性的偶发性收缩压大于或等于160 mmHg）。从20岁到65岁，总胆固醇水平随着年龄的增长而稳步上升，随后男性略有下降，女性趋于平稳。胆固醇水平升高在老年人中并不罕见（61%的65至74岁女性的总胆固醇水平超过6.2 mmol/L [240 mg/dL]）。根据现有数据，可以合理地得出结论，65岁以后，血脂升高虽然仍然是冠心病（CHD）的危险因素，但作为危险因素变得不那么明显，到75岁时，其预测价值已经消失。事实上，在老年人中，有证据表明高总胆固醇与长寿有关。在血清胆固醇升高的老年高血压患者中，有不同的风险报告。欧洲老年高血压工作组（EWPHE）试验表明胆固醇与死亡率之间存在负相关关系，而老年高血压项目（SMEP）试验表明胆固醇与死亡率之间存在正相关关系。有充分的文献证明，在80岁以下收缩压超过160 mmHg的老年高血压患者中，抗高血压治疗与显著的减少中风和心血管事件。饮食调整在降低老年人胆固醇方面的功效得到了一些研究的支持，但并非所有研究都支持。使用他汀类药物的三项主要干预试验表明，在70-75岁的老年冠心病患者中，降脂治疗可能是有益的。这些和其他试验的经验表明，他汀类药物在老年人中通常耐受良好。将这些结果外推到患有高血压和胆固醇水平升高但未确诊冠心病的老年患者中是困难和过早的。在常规提示对无冠心病证据的老年高血压患者降低胆固醇是有利的之前，需要进一步的试验。可能有大量患者需要治疗。
Hypertension is often associated with other risk factors for cardiovascular disease, including elevated levels of cholesterol, and casual systolic hypertension is a very prevalent finding in the elderly (50% of women over the age of 80 have casual systolic blood pressures greater than or equal to 160 mmHg). Total cholesterol levels steadily increase with age from 20 to 65, following which they decrease slightly in men and tend to plateau in women. Elevated cholesterol levels are not uncommon in the elderly (61% of women aged between 65 and 74 have total cholesterol levels over 6.2 mmol/L [240 mg/dL]). From the data available, it is reasonable to conclude that after the age of 65, increased blood lipids, although still a risk factor for coronary heart disease (CHD), become less pronounced as risk factors and that by 75 years of age their predictive value has disappeared. Indeed, in the very elderly, there is evidence to suggest that high total cholesterol is associated with longevity. In elderly hypertensives with elevated serum cholesterol, differing risks have been reported. The European Working Party on Hypertension in the Elderly (EWPHE) trial suggested a negative relationship between cholesterol and mortality, while the Systolic Hypertension in the Elderly Program (SMEP) trial suggested a positive relationship.With regards to intervention, it is well documented that antihypertensive treatment in elderly hypertensives up to the age of 80 who have blood pressures over 160 mmHg systolic is associated with significant reductions in stroke and cardiovascular events. The efficacy of dietary modification in reducing cholesterol in the elderly has been supported by some studies but not by all. Three major intervention trails using statins have shown that in elderly patients up to the age of 70-75 who have established CHD, lipid-lowering therapy can be of benefit. The experience from these and other trials suggests that statins are generally well tolerated in the elderly. It is difficult and premature to extrapolate these results to elderly patients who have hypertension and raised cholesterol levels without established CHD. Further trials are required before routinely suggesting it is advantageous to lower cholesterol in an elderly hypertensive who does not have pre-existing evidence of CHD. It is possible that large numbers may prove to require treatment.