UH scientists find
lower cholesterol
hurts elderly

A study reveals that aggressive
treatment could be harmful

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By Leila Fujimori
lfujimori@starbulletin.com

Lowering cholesterol levels among the elderly may actually increase death rates, according to the results of a study by Hawaii scientists being published tomorrow in the British medical journal the Lancet.

"Very aggressive treatment of cholesterol in the elderly is unwarranted," said Irwin Schatz, lead author and professor of medicine at the John A. Burns School of Medicine at the University of Hawaii.

"I used to be like most other physicians or cardiologists, treating cholesterol very aggressively no matter how old the patient," Schatz said.

The study has altered the way he now treats his elderly patients over 75.

"I really don't like to lower their cholesterol to below 180."

The study has drawn international media attention, with Schatz fielding calls from around the world. Schatz co-authored the study with Kamal Masaki, Katsuhiko Yano, Randi Chen, Beatriz Rodriguez and David Curb.

High blood cholesterol is known to be directly related to mortality in persons 65 and younger from heart disease due to hardening of the arteries. Schatz continues to support treatment of cholesterol for those in that age group.

"The implication is different between younger people and elderly people," Yano said.

The study found a statistical relation with extremely low levels of serum cholesterol -- 160 mg per deciliter or lower --- among those 75 years and older and mortality by all causes.

General guidelines for total blood cholesterol levels are below 200 mg per deciliter; above 200 to 240 is borderline; 240 is high.

In the study, those with the lowest mortality rate was found among those whose levels were between 200 and 220, while those with the highest mortality rate, 20 percent of the subjects, had cholesterol levels lower than 160.

Several similar studies have been conducted in Japan, the United States and Europe indicating such a relationship between low cholesterol and high mortality among only the elderly, co-author Yano said.

But Yano emphasized this does not mean low cholesterol causes death. He said some subjects with low cholesterol already had some chronic disease, so had a higher death rate. But even after adjustment for chronic disease, there was still a significant relation, he said.

The study is based on data collected from the 1991-1993 study of 3,572 Japanese-American men who were the survivors of the original 8,000 subjects of the ongoing Honolulu Heart Program.

The men examined during the 1991-1993 period with lower cholesterol levels had higher mortality in the six-year follow-up exam.

Interestingly, those men who had lower cholesterol levels in the 1991-1993 exam had lower cholesterol rates 20 years earlier. But Yano would not recommend raising cholesterol levels among younger people, rather suggesting the opposite.