By Beverly Creamer
Advertiser Health Writer
Those older than 70 with a low cholesterol level face an increased risk of heart disease, according to startling new findings from a Honolulu Heart Project study.
The study appears to show that as people age, the cholesterol levels considered healthiest are different from those recommended for younger people.
"People have the impression that the lower the cholesterol, the better," said Beatriz L. Rodriguez, lead Honolulu Heart Project researcher and a professor of medicine at the University of Hawai‘i John A. Burns Medical School.
But in the elderly, she said, the optimal cholesterol level is between 200 and 219 milligrams per deciliter of blood, not below 200, the recommended level for the young and middle aged.
According to a study that followed 2,424 men over a six-year period, the healthful cholesterol range for older people is rather narrow. In addition, they face a higher risk of heart disease if their cholesterol level is too low. It is the first study to find a differential in cholesterol levels according to age.
"Lowering high cholesterol in the young and middle-aged makes sense, based on scientific studies," said co-author and co-researcher Dr. David Curb who heads the heart project. "However, I’m not sure that’s the case with the elderly, and this research makes the argument that we ought to be careful about making that assumption."
Rodriguez and Curb announced their findings yesterday at the American Heart Association’s 41st Annual Conference on Cardiovascular Disease Epidemiology and Prevention in San Antonio.
The researchers tracked the cholesterol levels of 2,424 men aged 71-93 from the original Honolulu Heart Project, a study that began in 1965 at Kuakini Medical Center with more than 8,000 men of Japanese ancestry. While the project was first started to measure the effects of migration on health, including changing diet and lifestyle, it has evolved in the past decade to look at more precise measurements of health and disease.
About 2,800 of the original participants are still alive. However, the latest analysis excluded those who already have developed heart disease, suffered a stroke, or are taking medication for either.
The men were divided into six categories according to cholesterol levels. Those with cholesterol above 240 had a 90 percent greater risk of developing heart disease. That was expected, said Rodriguez and Curb.
What wasn’t expected was that those with cholesterol below 160 had a 55 percent higher risk of developing heart disease.
Those with cholesterol levels between 200 and 219 had the lowest rate of coronary heart disease.
"The question this study raises is how aggressive you should be in lowering cholesterol. Some physicians want it the lower the better, and that may not be true," said Rodriguez.
Both point out that these new findings should encourage doctors to treat older people for levels of cholesterol higher than 240.
Dr. Irwin Schatz, another co-investigator, said researchers don’t yet understand why lowering cholesterol too far may be dangerous. But there are ways to modify high cholesterol moderately, he said.
"The most powerful lipid-lowering drugs, the statins, lower cholesterol the most, but you can’t predict how much," said Schatz, also a professor of medicine at the University of Hawai‘i.
Instead of medication he recommends trying an over-the-counter remedy as a first step.
"There are naturally occurring vegetable oils (called sterols or sitosterols) that don’t require a prescription but lower cholesterol by 10-15 percent," said Schatz. One of them, a spread called Benecol that’s an alternative to butter, is available at local grocery stores.
If this doesn’t provoke at least a moderate change after three months, Schatz prescribes a cholesterol-lowering medication.
The research team has applied for another National Institutes of Health grant to follow the men in the Honolulu Heart Project for another five years. The researchers say it is important to do more such clinical trials that include the elderly to continue to clarify this issue.
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