This Article Free upon publication Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gotto, A. M. Search for Related Content PubMed PubMed Citation Articles by Gotto, A. M., Jr Related Collections Lipids Secondary prevention Risk Factors

(Circulation. 2007;115:681-683.)
© 2007 American Heart Association, Inc.

Editorial

Statin Therapy and the Elderly

SAGE Advice?

Antonio M. Gotto, Jr, MD, DPhil

From Weill Cornell Medical College, New York, NY.

Correspondence to Antonio M. Gotto, Jr, c/o Jesse Jou, Weill Cornell Medical College, 445 E 69th St, OH205, New York, NY 10021. E-mail amg_editorial@med.cornell.edu

Key Words: Editorials • aging • coronary disease • drugs • prevention • risk factors • statins

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
In the United States, the prevalence of coronary and other cardiovascular diseases increases with age, reflecting in part the cumulative effect of lifetime exposure to cardiovascular risk factors.¹ Coronary and cerebrovascular atherosclerosis in the elderly (65 years of age) is a growing clinical problem because of the population’s increasing longevity. Despite this evidence, cardiovascular risk in elderly patients is demonstrably undermanaged according to several epidemiological studies.^2–4 In a Canadian study, paradoxically, elderly coronary patients who were at the highest risk for recurrent disease appeared to be the least likely to receive preventive treatment.⁴ Several factors may contribute to this poor level of management, such as confusion surrounding the relevance of certain modifiable risk factors to this age group, the cost-effectiveness of preventing coronary heart disease (CHD) in older patients, and concerns about the impact of therapies on safety and quality of life.

Article p 700

Despite early studies that questioned the association of cholesterol with coronary risk in the elderly, the available epidemiology now favors the perspective that cholesterol remains an important modifiable risk factor in patients 65 years of age, especially after adjustment for the presence of comorbid conditions.⁵ Growing evidence demonstrates the benefit of treating higher-risk older patients. In this issue of Circulation, Deedwania et al⁶ present the results of the Study Assessing Goals in the Elderly (SAGE), which compares the effect of intensive (atorvastatin 80 mg/d) compared with moderate (pravastatin 40 mg/d) cholesterol lowering with statins in a cohort of 893 men and women 65 . . . [Full Text of this Article]