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Eligibility for Cholesterol Referral in Community-dwelling Older Adults: The Cardiovascular Health Study

Teri A. Manolio, MD, MHS; Curt D. Furberg, MD; Patricia W. Wahl, PhD; Russell P. Tracy, PhD; Nemat O. Borhani, MD, MPH; Julius M. Gardin, MD; Linda P. Fried, MD, MPH; Daniel H. O'Leary, MD; and Lewis H. Kuller, MD, DrPH
[+] Article, Author, and Disclosure Information

Affiliations: From the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the Bowman Gray School of Medicine, Winston-Salem, North Carolina; the University of Washington, Seattle, Washington; the University of Vermont, Burlington, Vermont; the University of California, Irvine, Orange, California; The Johns Hopkins University, Baltimore, Maryland; Geisinger Medical Center, Danville, Pennsylvania; and the University of Pittsburgh, Pittsburgh, Pennsylvania.

Grant Support: By contracts N01-HC-85079, N01-HC-85080, NOl-HC-85081, N01-HC-85082, N01-HC-85083, N01-HC-85084, N01-HC-85085, and N01-HC-85086, from the National Heart, Lung, and Blood Institute.

Requests for Reprints: CHS Coordinating Center, University of Washington, JD-30, 1107 N.E. 45th Street, Suite 530, Seattle, WA 98105.

Current Author Addresses: Dr. Manolio: CGEB/DECA/NHLBI, Federal Building, Room 301, 7550 Wisconsin Avenue, Bethesda, MD 20892.

Drs. Wahl and Borhani: CHS Coordinating Center, University of Washington, JD-30, 1107 NE 45th Street, Suite 530, Seattle, WA 98105.

Dr. Furberg: Department of Public Health Sciences, Bowman Gray School of Medicine, 300 S. Hawthorne Road, Winston-Salem, NC 27103.

Dr. Tracy: Department of Pathology, University of Vermont, Medical Alumni Building, Burlington, VT 05405.

Dr. Fried: Johns Hopkins Hospital, Carnegie 296, 600 North Wolfe Street, Baltimore, MD 21205.

Dr. O'Leary: Division of Radiology, Geisinger Medical Center, Danville, PA 17822.

Dr. Gardin: Division of Cardiology, Route 81, UC Irvine Medical Center, 101 City Drive South, Orange, CA 92668.

Dr. Kuller: University of Pittsburgh, Rm. 1-526, Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA 15261.

Ann Intern Med. 1992;116(8):641-649. doi:10.7326/0003-4819-116-8-641
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Objectives: To assess the proportion of community-dwelling adults aged 65 years or older who are eligible for referral for lipoprotein analysis and intervention according to the National Cholesterol Education Program (NCEP) guidelines.

Design: Cross-sectional study based on examinations and questionnaires collected in 1989 and 1990.

Setting: Four communities in the U.S. in the Cardiovascular Health Study (CHS), a study of risk factors for heart disease and stroke in older adults.

Participants: A sample of 4810 men and women ages 65 to 100 randomly selected and recruited from Health Care Financing Administration Medicare eligibility lists for the four communities; not institutionalized, not wheelchair-bound, not currently receiving therapy for cancer, not currently taking lipid-lowering medications, and not having eaten in the preceding 9 hours.

Measurements: Total cholesterol and lipoprotein analysis measured in all participants.

Results: Total cholesterol levels were less than 5.17 mmol/L (200 mg/dL) in 37% of participants, 5.17 to 6.19 mmol/L (200 to 239 mg/dL) in 39%, and 6.20 mmol/L (240 mg/dL) or greater in 24%. Compared with their counterparts, older participants, especially those over 80 years of age, were more likely to have levels below 5.17 mmol/L, as were men, nonwhites, and those with coronary heart disease or two or more coronary heart disease risk factors (P < 0.008 for all values). Based on this screening measurement, 2174 participants were eligible for lipoprotein analysis, 80% were eligible for dietary or drug therapy using NCEP guidelines. Overall, 46% of CHS participants were eligible for lipoprotein analysis and 36% for intervention by NCEP guidelines, based on a single cholesterol measurement.

Conclusion: A substantial proportion of older adults in this community sample were eligible for lipoprotein analysis and intervention. Prospective studies of elderly persons are needed to determine the risk for incident coronary heart disease according to NCEP classifications and the benefits of lipid-lowering treatments in persons in this age group so that intervention strategies may best be targeted to an appropriately high-risk group.





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