Cholesterol Treatment for the Elderly
For many years, cholesterol has been publicized as one of the greatest obstacles to good health. Everywhere you look advertisements touting the virtues of a given cholesterol-lowering medicine are plastered to lure consumers. Recently, some doctors have even recommended checking cholesterol levels in children. Unfortunately, cholesterol treatment is not without side effects. One group that could be significantly at risk is the elderly. When rationalizing treating cholesterol levels in this group, a caregiver also needs to take into account other factors that can be negatively affected by treatment.
Cholesterol is a natural part of our body and is essential for normal function. It is needed in the brain and around our nerves and is also the raw material for many necessary hormones in the body. For several years, conventional medicine and patients alike have treated cholesterol like it was an infectious agent that needs to be cleared from the body. In truth, cholesterol patterns should be used as a guide and education tool to better instruct each individual on dietary, exercise and lifestyle habits to improve their overall health. High cholesterol can indicate that the individual is getting too much sugar and processed food and not enough vegetables, fruit and healthy protein. A cholesterol panel that shows elevated triglycerides might also indicate too much sugar in the diet. Also, it cannot be overstated how important it is to avoid bad hydrogenated or partially hydrogenated oils and instead take in healthy fats from fish, nuts and avocado.
Many considerations should be taken into account when treating the elderly for high cholesterol. One major factor is drug side effects. Statin drugs like Lipitor, Zocor and Pravachol have become standard treatments for high cholesterol. These drugs are not without issues. Common side effects can include liver changes and muscle aches. The muscle aches can become very serious. An elderly individual who already suffers from arthritis might not realize that increased pain is coming from a new cholesterol medication. If the muscle pain goes on long enough, it can lead to serious muscle damage. For the elderly, this could be a tremendous problem given increased risks of muscle loss, weakened bone density and the risk of falling.
Another side effect of the statin medications is the loss of the vitamin Coenzyme Q10, or CoQ10. This vitamin is vital for energy production within our cells, and statin drugs decrease its production. This vitamin benefits nearly every organ in the body. Individuals who are treated with statin medications should strongly consider supplementing with 100-200 mg of CoQ10 daily, with meals.
Certain medications, such as atorvastatin (Lipitor), simvastatin (Zocor) and lovastatin (Mevacor) affect some of the metabolizing pathways in the liver called the CYP3A4 pathway [Source: Law]. This means that these drugs might affect other medications that are also metabolized through the same pathway. It isn't rare for an elderly patient to have several medications started by several different doctors. This sets up the potential for drug side effects that may be difficult to sort through. Another big problem with statin drugs is the cost. These drugs can be very expensive, a tough problem for the elderly who often pay for medications on a fixed income. So, while these medications are typically effective in lowering cholesterol, their side effects and costs are significant drawbacks.
Statin drugs have successfully lowered the rates of cholesterol and heart attack in many patients, but usually these studies used middle-age focus groups. One study did include patients up to 82 and did show some success in treatment against heart disease [Source: Shepherd]. In patients 85 and older, it is debatable whether treatment should be given for high cholesterol if there is no evidence to do so. This same study found that even though the heart disease rates might have improved, rates of cancer increased in the drug treatment group. With lifetime cancer risks being 1 in 2 for men and 1 in 3 for women, we could be dealing with even higher rates if high cholesterol is aggressively treated for everyone, including the elderly.
One of the greatest concerns for the 85 and older population is loss of memory and brain function. Dementia is very common in this age group. Studies indicate dropping cholesterol late in life might not be good for brain function [Source: Solomon]. Fortunately, cholesterol studies have not shown that everyone taking statins will be at risk for dementia [Source: Arvanitakis]. Medical professionals are then faced with the question of whether or not there is sufficient data to make this judgment for those over 85 whose risk for dementia is at least 50 percent.
Cholesterol treatment has now made its way into conventional medicine. Indeed, the focus on cholesterol has probably helped increase awareness on diet and hopefully will lead to better awareness of the role of bad fats and inflammation. For the elderly population, cholesterol treatment is more than just following a number. It means taking into account potential side effects, drug interactions, cost and cancer risks. Keep these ideas in mind when weighing the pros and cons of cholesterol treatment in this age group.
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