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Treating Dyslipidemia in Old Age
by: Dan Noyes


As the percentage of elderly people in the United States continues to grow faster than any other age group, the incidence of CVD grows too. According to Kannel , 1 CVD accounts for 58% of the mortality in persons >85 years, and the incidence of atherosclerotic disease in persons >65 years is more than double that in middle-aged persons.

Can anything be done to reduce fatal CVD in a population exposed to a lifetime of CV risk factors?

Despite skepticism from some physicians, Kannel thinks CV risk can be reduced in this population (see below); he cites studies showing that correction of hypertension and dyslipidemia reduces morbidity and mortality in both middle-aged and elderly people. The effectiveness of other measures has not been established but appears to warrant investigation, including:

• reducing homocysteine levels

• reducing fibrinogen levels

• smoking cessation

• exercise

• weight reduction

Implications of Dyslipidemia in older populations:

About 25% of men and 42% of women >65 years have serum TC levels >240 mg/dL, the level at which NCEP ATP-II guidelines recommend treatment. 2 Citing the Framingham Heart Study, Kannel notes that the median serum TC at which coronary events occurred was only 221 mg/dL in men and 246 mg/dL in women, leading to the conclusion that 50% or more coronary events in the elderly can be expected to occur at cholesterol levels below those recommended by NCEP ATP-II for initiating treatment. 1

What should the clinician look for?

Although total blood lipids measured after age 65 have not been consistently found to correlate with the development of coronary disease or the occurrence of strokes, when cholesterol fractions other than TC are evaluated, positive relations have been found: for example, the TC:HDL-C ratio efficiently predicts CHD in the elderly as well as the middle-aged. 1 According to NCEP guidelines, patients should not be excluded from consideration from lipid-regulating therapy on the basis of age alone, although quality-of-life issues acquire special importance in managing older patients. Because both dietary and drug therapy have additional clinical implications for older patients, treatment of the elderly should be individualized.

Are older patients getting adequate treatment?
Although the use of pharmacologic cholesterol lowering in middle-aged patients is generally accepted and is increasingly utilized, patients aged 65 to 75 who have a history of CHD and might benefit from cholesterol-lowering drugs are generally undertreated or not treated at all, according to a recent CHS report by Lemaitre et al. 3 The CHS was designed to investigate risk factors for CHD in men and women aged 65 and older (see below). It also provided an opportunity to examine the impact of the NCEP guidelines on physicians' prescribing patterns for elderly patients.


About the author:
Copyright 2005, Dan Noyes
I write articles for http://www.dyslipidemia.org,which provide free Online CME (Continuing Medical Education) activities.



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 How To Quit Smoking
 by: Rob Mellor

One of the most vicious diseases in today’s times is smoking. It makes a person baffle for air 3 times more than a non-smoker. It has very many repercussions on the life of the smoker and those around him. It leads to lung cancer and various heart diseases like asthma and emphysema. We should thus abhor this deadly disease and quit smoking.

Quitting is not easy

But to actually quit smoking is not easy, because it is an addiction. However there are very many ways and methods that help us to quit smoking for instance we can opt for acupuncture therapy or aromatherapy. We can also opt for non-nicotine cigarettes or go for precise prescription by a doctor.

But first and foremost we need to decide in our heart to stop smoking and should also fix a day for the same. Inform your family about your decision and seek for their help and assistance. Throw away all the cigarette packets, ashtrays and lighters. Stop buying any more cigarettes. Rather think of the more useful and better things that you can buy with the money thus saved. Ask the other family members also, who smoke, to stop smoking. Keep yourself busy. Exercise regularly and meditate occasionally. Eat healthy food.

After doing all this you may still feel severe urges to smoke. You may also actually retort back to it, but that’s no problem, just be persistent and bring back your decision on to the right track after this break, because most of the people are successful only after 2-3 attempts.

Be prepared for withdrawal symptoms

About 80% people retort back to smoking after once leaving it and only 20% successfully accomplish the task. People retort back due to many reasons. Some say they feel agitated. Others say that the aroma when someone lights up is irresistible. But most of them do so due to the fear of symptoms that appears after that last puff viz. weight gain, aggressive thinking, dry throat, fatigue, muscle cramps, constipation, dizziness, hypersensitivity to stimuli, etc. but these are all just temporary symptoms and disappear in a few days. In fact after the initial bout is over the blood pressure, heart rate, pulse arte all get back to normal. You thus need to keep your will power strong and stick to your decision for a few more days.

Some people are not able to continue with the smoke cessation programs because they say that they are costly. But this is a wrong perception because they are not costlier than the price spent for buying cigarettes. And then isn’t it more logical to spend on your health rather on a disease.

 

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