[Prevention of cardiovascular diseases in elderly subjects with hypercholesterolemia].

Cardiovascular diseases are frequent in elderly subjects and these patients also frequently present with hyperlipidaemia. Therapy must take current uncertainties into account and, in the absence of therapeutic studies carried out in the elderly, is typically based on a case-by-case approach. Raised cholesterol levels remain a significant risk factor for coronary heart disease (CHD) in the elderly. Although the relative risk of CHD tends to diminish with increasing age, this reduction is accompanied by an increase in absolute risk (i.e. the number of events) as the frequency of the illness increases markedly with age. The results of major outcome studies with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), when analysed according to patient age, indicate that the benefits of these agents are not merely confined to younger individuals. However, the elderly form a unique patient population: the proportion of women is greater and the profile of cardiovascular illnesses is characterized, among other things, by a greater incidence of cerebrovascular accidents. Moreover, the potential widespread treatment of hyperlipidaemia in the elderly has profound economic implications. Under these circumstances, the clinical practice recommendations depend upon a reasonable extrapolation of epidemiological and therapeutic data obtained from middle-aged men. At present, treatment is therefore aimed at patients with the most severe forms of hyperlipidaemia, generally in the secondary prevention setting, taking into account the patient's life expectancy.