The controversy surrounding cholesterol treatment in older people.

The evidence of the benefit of lowering cholesterol levels in seniors from epidemiologic studies and RCTs is conflicting. Epidemiologic studies suggest that elevated cholesterol levels in elderly people may be a marker of good health. In some cases, lowering cholesterol in seniors may even prove harmful. Conversely, RCTs of lipid-lowering therapy have shown clear benefits in reducing coronary events in younger and middle-aged adults with or without pre-existing CAD. Both the epidemiologic studies and the RCTs we evaluated have methodologic concerns that make generalization to all seniors difficult. One epidemiologic study, in fact, found that there may be a physiologic decline in cholesterol levels as people age into their 70s and beyond [16]. We still do not appear to have a clear insight into the precise role cholesterol plays in seniors, especially those over the age of 75. In the future, as more data becomes available from RCTs and meta-analyses evaluating seniors in the older age group [15], we hope to have a better understanding of how to treat hypercholesterolaemia in this population. Until further studies are published, treatment plans need to be individualized, and the risks and benefits of treatment on various outcomes must be weighed according to the best evidence we have available.