The symposium was opened by Professor Lale Tokgozoglu (Ankara, Turkey) with the presentation “How do lipids change with age?”. She stressed that total cholesterol and triglycerides increase until about the age of 60 years and decline after about 70.
Several genetic/environmental factors account for changes in lipid metabolism with ageing. More than half the variance in lipids can be explained by genetic factors. Endocrinologic changes, BMI changes and others all have an impact in that LDL FCR decreases, VLDL apo B production increases, skeletal muscle LPL activity decreases and adiposity, particularly abdominal, increases with age.
The decrease in cholesterol after 75 years might be explained by a lower intake of fatty calories and reduced absorption of cholesterol. HDL cholesterol remains relatively stable with age, but the antioxidant activity of HDL decreases. Therefore, a low HDL in the elderly is a more important risk factor than a high LDL. A possible explanation for this might be the pleiotropic effects of HDL. Lifestyle modifications may also improve the lipid profile in the elderly.
The second presentation was by Dr V. Andres Garcia entitled “Age and atherosclerosis – which lessons have we learned?”. He stressed the role of telomeres shortening (which is a feature of normal ageing). In particular, it seems that telomeres shortening is detrimental for the function of the heart and is associated with a higher rate of mortality from heart diseases. Telomeres shortening in leukocytes might be a surrogate marker of cardiovascular risk, and not a detrimental risk factor. However, there are also data indicating that telomeres shortening might be beneficial for atherosclerosis progression.
Professor Evan Stein (Cincinnati, USA) in his presentation “Is treatment of hyperlipidaemia in the elderly the same as in the young” gave an overview on recent trials dealing with this topic. He concluded that statin therapy in the elderly is a cost-effective therapy, particularly because of a higher risk in this age group. The elderly have an LDL reduction greater than in the young (3-4%), with the same dose of statin.
Therefore, and because of other reasons, the elderly, especially women >65 years, appear to be more predisposed to serious side effects of statin treatment. Initiation of anti-lipemic therapy in the elderly (>80 years) should be carefully examined in the context of co-morbidities and the increased use of medication in this population should be monitored.
In the last presentation Professor Andreas Mezzetti (Chieti, Italy) stressed the underuse of lipid-lowering therapy in the elderly. He presented evidence that in patients with CHD >65 years (also in those >80 years) statins reduce cardiovascular mortality, but he also pointed out that in patients >80 years the evidence supporting the use of statins in primary prevention is lacking.