Aggressive risk factor management in the elderly: Are you ever too old?

Smoking, hypertension, and hyperlipidemia are the three most important modifiable risk factors contributing to the development of cardiovascular disease in older adults. Although the magnitude of risk associated with smoking and hyperlipidemia declines with age, the absolute number of cases attributable to these risk factors increases due to the increasing prevalence of cardiovascular disease. Smoking increases the risk of both coronary events and stroke in the elderly, and there is evidence that smoking cessation is associated with a rapid reduction in risk. Therefore, an aggressive effort to promote smoking cessation is strongly recommended in patients of all ages. Systolic and diastolic hypertension are powerful risk factors for cardiovascular disease in the elderly. Moreover, multiple clinical trials have demonstrated that blood pressure reduction reduces the risk of stroke, coronary events, heart failure, and cardiovascular death in individuals at least up to the age of 90. Accordingly, treatment of both systolic and diastolic hypertension are strongly recommended regardless of patient age. The importance of total serum cholesterol as a coronary risk factor declines with age, but the ratio of low density lipoprotein cholesterol (LDL-C) to high density lipoprotein cholesterol (HDL-C) remains an independent predictor of coronary events in older men and women. In addition, clinical trials have shown that cholesterol reduction is associated with improved clinical outcomes in individuals ≤ 75 years of age. At the present time, the value of treating hyperlipidemia in patients >80 years of age is unknown, and therapy in this age group must be individualized.