High blood cholesterol in elderly men and the excess risk for coronary heart disease
Coronary heart disease is a condition characterized by decreased blood flow to the heart. If this condition is not treated, the heart can sustain severe damage. An important risk factor in the development of coronary artery disease, at least in young and middle-aged individuals, is elevated plasma cholesterol (hypercholesterolemia). High cholesterol levels are known to promote the formation of fatty plaques on the inner surface of the coronary arteries, eventually causing a reduced blood supply to the heart. The degree to which hypercholesterolemia increases the risk of coronary artery disease in elderly individuals is controversial. To investigate the role of hypercholesterolemia in the development of coronary heart disease in the elderly, a study was carried out with 2,746 white men, between the ages of 60 and 79, who were members of the Kaiser Permanente Medical Care Program. Subjects were classified according to plasma cholesterol levels, and were followed for an average of 10 years. The relative risk of developing coronary heart disease (derived from the ratio of coronary heart disease incidence in the upper quartile of plasma cholesterol to that in the lower three quartiles) was similar across all ages, ranging from 1.4 in the 60-to-64 age group to 1.7 in the 75-to-79 age group. However, when the excess risk of hypercholesterolemia (the difference in mortality in the highest quartile compared with the lower three quartiles) was calculated, it was found to increase with age. The range was from 2.2 additional deaths in the youngest group to 11.3 in the oldest group. These results indicate that cholesterol-lowering treatment may be more effective in preventing mortality in elderly men than in younger men. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Lifetime risks of hip, Colles', or vertebral fracture and coronary heart disease among white postmenopausal women
Osteoporosis is a reduction of calcium in the bones of postmenopausal women as a consequence of decreased sex hormone secretion. The condition results in a frailty of the skeleton that puts these patients at risk for vertebral and other bone fractures. Although treatment with the female sex hormone estrogen is useful and effective, it may lead to increased risks of coronary heart disease and cancer of the breast and uterus. Lifetime risk is a calculated statistic indicating the probability of developing a particular condition during one's life. It is used in this study to evaluate the value of treatment of osteoporosis in postmenopausal women. A woman who is 50 years of age has a 16 percent risk of sustaining a hip fracture and a 32 percent risk of a vertebral fracture before her death. Her risk of dying of breast cancer is 2.8 percent, and she has a 0.7 percent risk of dying from endometrial cancer, a form of uterine cancer. The lifetime risk of death from coronary heart disease for this hypothetical patient is 31 percent. This study does not intend to measure the benefits of postmenopausal hormone therapy or to determine definitively whether such treatment is appropriate. This study does, however, suggest that the benefits and risks of such replacement endocrine therapy to ward off the deleterious effects of fractures must take into consideration its influence in increasing the incidence of heart disease and other conditions.
Publication Name: Archives of Internal Medicine
Factors associated with appendicular bone mass in older women
Age, weight, muscle strength and use of estrogen appear to be the greatest predictors of bone mass in elderly women. Declines in bone mass increase the risk of fracture, and fractures are a major cause of disability among older women. Bone mass was measured in 9,704 women over the age of 65. Bone mass was strongly associated with age, declining by about 5% every five years after age 65. Bone mass increased significantly with weight and muscle strength. Late menopause was also significantly associated with high bone mass. There was no association between calcium intake and bone mass, and there was no association between alcohol intake and bone mass. Smoking and caffeine were associated with lowered bone mass. Bone mass increased with estrogen use and with use of the drug thiazide. Non-insulin-dependent diabetes was associated with higher bone mass while gastrectomy, which is the total or partial removal of the stomach, was associated with lower bone mass.
Publication Name: Annals of Internal Medicine
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