HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Aronow, W. S. Search for Related Content PubMed Articles by Aronow, W. S.

Author's Response to Commentaries

Department of Medicine, Divisions of Cardiology, Geriatrics, and Pulmonary/Critical Care Medicine, Westchester Medical Center/New York Medical College, Valhalla.

Address correspondence to Wilbert S. Aronow, MD, FGSA, Cardiology Division, New York Medical College, Macy Pavilion, Rm. 138, Valhalla, NY 10595. E-mail: wsaronow{at}aol.com

Since submitting my article (1) recommending that the NCEP III guidelines be modified in elderly and younger persons at high risk for cardiovascular events, the NCEP III guidelines have been updated (2). The updated NCEP III guidelines recommend reducing the serum low-density lipoprotein (LDL) cholesterol in very high risk persons to <70 mg/dl instead of <100 mg/dl, regardless of age or gender (2). Persons with two or more risk factors and a 10-year risk for coronary heart disease of 10% to 20% should have their serum LDL cholesterol reduced to <100 mg/dl instead of <130 mg/dl, regardless of age or gender (2). Persons treated with lipid-lowering drug therapy should have their serum LDL cholesterol level reduced at least 30% to 40% (2). In low-risk persons with up to one risk factor, the serum LDL cholesterol target of <160 mg/dl remains unchanged (2). I agree with all of these recommendations.

On the basis of data from the Heart Protection Study (3) and the PROSPER study (4), Dr. Goodwin favors a more aggressive treatment of older persons with hypercholesterolemia and vascular disease or diabetes mellitus (5). His comments are excellent. Dr. Hazzard's comments are also excellent (6). I agree with all of them.

On the other hand, I disagree with Dr. Hirth's comments (7). In fact, the PROSPER study (4) was one of the studies used to support the NCEP III updated guidelines (2). The numerous deficiencies of the lipid-lowering arm of the ALLHAT trial (8) are well discussed in the NCEP III updated guidelines (2).

The comments by Drs. Levy and Pearson (9), Mooradian (10), and Nash (11) are excellent. I agree with all of them. Dr. Nash's comments are those of a cardiologist.

Dr. Wilson's commentary (12) is correct in stating that "Cardiologists will likely wholeheartedly agree with Dr. Aronow, while geriatricians will most probably issue the usual and rather monotonous battle cry of 'insufficient evidence.'" Hopefully, cardiologists will be able to educate reluctant geriatricians to accept the updated NCEP III guidelines (2) in order that we may reduce cardiovascular morbidity and mortality in elderly people.

References

78. Aronow WS. Should the NCEP III guidelines be changed in elderly and younger persons at high risk for cardiovascular events? [Special Article]. J Gerontol Med Sci. 2005;60A:591-592.
79. Grundy SM, Cleeman JI, Merz CNB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227-239.[Abstract/Free Full Text]
80. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:7-22.[Medline]
81. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339:1349-1357.[Abstract/Free Full Text]
82. Goodwin JS. What do we do for the very old? [Commentary on Aronow's "Should the NCEP III Guidelines Be Changed in Elderly and Younger Persons at High Risk for Cardiovascular Events?"]. J Gerontol Med Sci. 2005;60A:593-594.
83. Hazzard WR. Preventive gerontology: edging ever closer to the "barrier to immortality" [Commentary on Aronow's "Should the NCEP III Guidelines Be Changed in Elderly and Younger Persons at High Risk for Cardiovascular Events?"]. J Gerontol Med Sci. 2005;60A:594-595.
84. Hirth VA. Hyperlipidemia in seniors: too much, too little, too late? [Commentary on Aronow's "Should the NCEP III Guidelines Be Changed in Elderly and Younger Persons at High Risk for Cardiovascular Events?"]. J Gerontol Med Sci. 2005;60A:595-597.
85. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA. 2002;288:2988-3007.
86. Levy DR, Pearson TA. Commentary [On Aronow's "Should the NCEP III Guidelines Be Changed in Elderly and Younger Persons at High Risk for Cardiovascular Events?"]. J Gerontol Med Sci. 2005;60A:597-598.
87. Mooradian AD. Commentary. [On Aronow's "Should the NCEP III guidelines be changed in elderly and younger persons at high risk for cardiovascular events?"]. J Gerontol Med Sci. 2005;60A:598.
88. Nash IS. Aim low [Commentary on Aronow's "Should the NCEP III Guidelines Be Changed in Elderly and Younger Persons at High Risk for Cardiovascular Events?"]. J Gerontol Med Sci. 2005;60A:599-600.
89. Wilson MMG. Cholesterol and the aged: ...and the beat goes on [Commentary on Aronow's "Should the NCEP III Guidelines Be Changed in Elderly and Younger Persons at High Risk for Cardiovascular Events?"]. J Gerontol Med Sci. 2005;60A:600-602.

This article has been cited by other articles:

				W. S. Aronow Drug Treatment of Systolic and of Diastolic Heart Failure in Elderly Persons J. Gerontol. A Biol. Sci. Med. Sci., December 1, 2005; 60(12): 1597 - 1605. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Aronow, W. S. Search for Related Content PubMed Articles by Aronow, W. S.