Cholesterol: until which age 'the lower the better'?

In the elderly and particularly in the very elderly the prognostic role of hypercholesterolemia is uncertain and there are conflicting data from the literature. In some studies, the relation between high levels of cholesterol and cardiovascular events, strongly demonstrated for younger subjects, has been confirmed also in the elderly, conversely in other studies a relation between low cholesterol levels and higher mortality risk has been described, particularly in the very elderly. Furthermore, uncertainties regarding hypercholesterolemia treatment have been raised both in secondary and particularly in the primary prevention setting, because elderly subjects and particularly the very elderly have been excluded from randomized clinical trials. In this article the prognostic role of hypercholerlemia and its reduction in the elderly patients both in primary and secondary prevention settings are assessed.