Abstract
Lipid levels are increasing in all age groups in the Chinese population, but the use of statin treatment in the elderly is not well documented. We examined serum lipids, statin usage and achievement of lipid goals in 3950 subjects aged ≥65 years. Established CVD was present in 7.77% of participants and increased CVD risk was common. Elevated LDL-C according to CVD risk level was present in 46.70% of all subjects and was more frequent (p < 0.01) than elevated non-HDL-C at 32.58%. With increasing age, LDL-C was unchanged but triglycerides and non-HDL-C decreased and HDL-C increased. Individuals at moderate risk for CVD had higher TC, LDL-C, and non-HDL-C than low-risk subjects, but the values were lower in high- and very-high-risk individuals, probably because of the use of statin which was 28.57% in high-risk subjects with established CVD and 37.60% in very-high-risk individuals, but only 2.62% in those with estimated high-risk and 3.75% in those with high-risk from diabetes. More subjects in each risk group reached the non-HDL-C goal than the LDL-C goal because of the relatively low triglycerides and VLDL-C levels. These findings demonstrate a high prevalence of elevated LDL-C but low rate of statin treatment in elderly community-dwelling Chinese.
Highlights
China has experienced a rapid economic growth and aging of its population and the resulting increased prevalence of cardiovascular risk factors including tobacco use, unhealthy diet, reduced physical activity, increased serum cholesterol and glucose, obesity, overweight and hypertension has led to a significant increase in the occurrence of cardiovascular disease (CVD) which accounted for more than 37.8% of all deaths in 20101–3
Studies which examined the use of statins in patients at increased risk of CVD and the attainment of low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (HDL-C) goals have generally found a substantial proportion do not achieve the goals, but the use of statins in elderly people over age 75 or 80 years is controversial because of lack of evidence from clinical trials in this age group and observational studies showing an association of low cholesterol levels with increased mortality in the elderly
Shanghai is one of seven cities demonstrating aging and tremendous growth of CVD risk factors and their effects on cardiovascular health[15], the SHanghai Elderly Cardiovascular Health Study (SHECHS) was designed to recruit elderly residents aged ≥65 years living in the Pudong Gaohang Community Medical Center region of Shanghai to provide current and reliable data evaluating the CVD risk factor of high cholesterol in an elderly community population which will help to plan for better interventions to reduce the increasing number of CVD events
Summary
China has experienced a rapid economic growth and aging of its population and the resulting increased prevalence of cardiovascular risk factors including tobacco use, unhealthy diet, reduced physical activity, increased serum cholesterol and glucose, obesity, overweight and hypertension has led to a significant increase in the occurrence of cardiovascular disease (CVD) which accounted for more than 37.8% of all deaths in 20101–3. The increase in serum cholesterol was considered to be the major contributor for the rise of coronary heart disease (CHD) mortality in Beijing from 1984–1999 and was responsible for 77% of the increased mortality[8], and high cholesterol increased the risk for CHD and the risk for ischaemic stroke[9] Both low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) are recommended as targets for lipid lowering treatment for primary and secondary prevention of atherosclerotic CVD10–13. This article describes the prevalence of CVD and its major risk factor, serum cholesterol and provides details of the treatment and the attainment of LDL-C or non-HDL-C goals according to CVD risk level from low to very high CVD risk groups in the elderly population of a Chinese community.
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