03367nas a2200361 4500008004100000022001400041245010800055210006900163260001600232300001100248490000800259520237700267653000902644653002902653653002102682653001902703653001102722653001102733653002502744653000902769653001502778653001702793653001802810100001902828700001702847700001702864700001702881700001702898700002002915700001902935700001502954856003602969 1998 eng d a0003-992600aTime trends in the use of cholesterol-lowering agents in older adults: the Cardiovascular Health Study.0 aTime trends in the use of cholesterollowering agents in older ad c1998 Sep 14 a1761-80 v1583 a

OBJECTIVES: To describe recent temporal patterns of cholesterol-lowering medication use and the characteristics that may have influenced the initiation of cholesterol-lowering therapy among those aged 65 years or older.

SUBJECTS AND METHODS: A cohort of 5201 adults 65 years or older were examined annually between June 1989 and May 1996. We added 687 African American adults to the cohort in 1992-1993. We measured blood lipid levels at baseline and for the original cohort in the third year of follow-up. We assessed the use of cholesterol-lowering drugs at each visit.

RESULTS: The prevalence of cholesterol-lowering drug use in 1989-1990 was 4.5% among the men and 5.9% among the women; these figures increased over the next 6 years to 8.1% and 10.0%, respectively, in 1995-1996. There was a 4-fold increase in the use of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors during the 6 years of follow-up, from 1.9% of all participants in 1989-1990 to 7.5% in 1995-1996. The use of bile acid sequestrants, nicotinic acid, and probucol declined from initial levels of less than 1% each. Among the participants who were untreated in 1989-1990, but eligible for cholesterol-lowering therapy after a trial of dietary therapy according to the 1993 guidelines of the National Cholesterol Education Panel, less than 20% initiated drug therapy in the 6 years of follow-up, even among subjects with a history of coronary heart disease. Among participants untreated at baseline but eligible for either cholesterol-lowering therapy or dietary therapy, initiation of cholesterol-lowering drug therapy was directly associated with total cholesterol levels, hypertension, and a history of coronary heart disease, and was inversely related to age, high-density lipoprotein cholesterol levels, and difficulties with activities of daily living. Other characteristics that form the basis of the 1993 National Cholesterol Education Panel guidelines-diabetes, smoking, family history of premature coronary heart disease, and total number of risk factors-were not associated with the initiation of cholesterol-lowering drug therapy.

CONCLUSIONS: Given the clinical trial evidence for benefit, those aged 65 to 75 years and with prior coronary heart disease appeared undertreated with cholesterol-lowering drug therapy.

10aAged10aAnticholesteremic Agents10aCholesterol, LDL10aCohort Studies10aFemale10aHumans10aHypercholesterolemia10aMale10aPrevalence10aRisk Factors10aUnited States1 aLemaitre, R, N1 aFurberg, C D1 aNewman, A, B1 aHulley, S, B1 aGordon, D, J1 aGottdiener, J S1 aMcDonald, R, H1 aPsaty, B M uhttps://chs-nhlbi.org/node/1513