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IMPORTANCE Hypercholesterolemia is common among people older than 80 years. Substantial functional heterogeneity exists among older patients, and decision making for statin use differs in older patients relative to younger ones. OBJECTIVE To discuss the presentation, modifying factors, and treatment of hypercholesterolemia (usually with statins) among persons older than 80 years. EVIDENCE REVIEW MEDLINE and other sources were searched from January 1990 to June 2014. Personal libraries and a hand search of reference lists from guidelines and reviews from January 2000 to June 2014 were also used. FINDINGS No randomized clinical trials (RCTs) of statin or any other hypocholesterolemic medication included persons older than 80 years at baseline. Findings from 75- to 80-year-old patients enrolled in RCTs and information from observational studies support statin treatment for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) and probably in patients with diabetes without ASCVD. Harms from statin drugs are not increased in older patients, so the use of these agents for primary prevention is possible. Because people older than 80 years are biologically heterogeneous with varying life expectancy, may have frailty or comorbid conditions, and may take multiple medications, the decision to treat with statins must be individualized. CONCLUSIONS AND RELEVANCE Ideally, treatment of hypercholesterolemia for patients at risk of ASCVD should start before they turn 80 years old. No RCT evidence exists to guide statin initiation after age 80 years. Decisions to use statins in older individuals are made individually and are not supported by high-quality evidence. [ABSTRACT FROM AUTHOR]

The article presents a clinical trial examining the effects of Cuban sugar cane-derived policosanol on lipid levels of patients with hypercholesterolemia or combined hyperlipidemia. According to the article, sugar cane-derived policosanol in typical and high doses does not cause a decrease in lipid levels beyond the placebo in patients with hypercholesterolemia or combined hyperlipidemia. The article discusses low-density lipoprotein cholesterol levels, high-density lipoprotein cholesterol, and triglycerides.

Compares the efficacy of extended-release niacin (Niaspan) and gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Agents that raise plasma levels; Strategies for coronary risk reduction.

Reports on a randomized, controlled trial on the efficacy and safety of lovastatin in adolescent males with heterozygous familial hypercholesterolemia (HeFH), a common disorder associated with early coronary artery disease. Objective; Design; Setting; Patients; Main outcome measures; Results; Conclusions.

Presents a randomized comparative trial on the effect of casein and soy protein containing varying amounts of isoflavones on plasma concentrations of lipids and lipoproteins on hypercholesterolemic volunteers. Naturally occurring isoflavones isolated with soy protein lowering the plasma concentrations of total and low-density lipoprotein cholesterol.

Compares escalating doses of immediate-release and sustained-release niacin for efficacy in reducing low-density lipoprotein cholesterol levels and increasing high-density lipoprotein cholesterol levels. Testing for the occurrence of adverse reactions; Management of hypercholesterolemia.

An individual's blood cholesterol measurement may differ from the true level because of short-term biological and technical measurement variability. Using data on the within-individual and population variance of serum cholesterol, we addressed the following clinical concerns: Given a cholesterol measurement, what is the individual's likely true level? The confidence interval for the true level is wide and asymmetrical around extreme measurements because of regression to the mean. Of particular concern is the misclassification of people with a screening measurement below 5.2 mmol/L who may be advised that their cholesterol level is "desirable" when their true level warrants further action To what extent does blood cholesterol change in response to an intervention? In general, confidence intervals are too wide to allow decision making and patient feedback about an individual's cholesterol response to a dietary intervention, even with multiple measurements. If no change is observed in an individual's cholesterol value based on three measurements before and three after dietary intervention, the 80% confidence interval ranges from a true increase of 4% to a true decrease of 9%. [ABSTRACT FROM AUTHOR]

Objective: --To evaluate the effectiveness of a model blood cholesterol screening program.Design: --Principal components included physician education, community-based screenings, and follow-up. A lay or professional educator provided counseling and referral advice. Half of the subjects with high blood cholesterol levels received a reminder to see their physician.Setting: --135 sites in four Massachusetts communities.Participants: --10,428 adults. Males, the young, the poor, the less educated, and minorities were underrepresented.Main Outcome Measures: --Referral completion rates, blood cholesterol changes.Results: --51.5% of those referred had visited their physicians within 2 to 4 months, increasing to 65.6% within 6 to 12 months. Older age (odds ratio [OR], 1.17 per additional decade), more education (OR, 1.17 per additional level), higher blood cholesterol levels (OR, 1.19 per additional 0.51 mmol/L), previous knowledge of level (OR, 1.34), and receiving a reminder (OR, 1.24) were significantly associated with greater likelihood of referral completion, whereas the type of educator providing counseling was not. Physicians had remeasured the blood cholesterol level of 76% of those seen, given dietary counseling to 70%, and prescribed medication to 15%. Significant changes in dietary fat were reported by both compliers and noncompliers with advice to follow up with their physicians. Six months after screening, blood cholesterol levels were 3.6% lower in noncompliers, 4.4% lower in compliers not taking cholesterol-lowering medications, and 8.8% in compliers taking such medications.Conclusions: --An effective, community-based blood cholesterol screening program can attract diverse populations and can result in most participants with high levels following up with their physicians, making dietary changes, and lowering their cholesterol levels. Additional strategies may be needed to attract underrepresented groups and to reduce the apparent overuse of cholesterol-lowering medications. [ABSTRACT FROM AUTHOR]

Presents a study, the objective of which is to determine the proportion of volunteer women with established heart disease who have low-density lipoprotein cholesterol levels at or below the National Cholesterol Education Program Adult Treatment Panel goals. Efforts to determine what factors are associated with levels above goal or not receiving lipid-lowering medication when indicated; Design; Setting; Patients; Results; Conclusion.

Tests the feasibility of cholesterol lowering in physician office practices using the National Cholesterol Education Program Adult Treatment Panel I guidelines. Recruitment of 22 physician practices in phase 1 and 23 in phase 2 from communities in western Pennsylvania and West Virginia; Treatment of patients with hypercholesterolemia; Impact of nutrition intervention on serum cholesterol levels.

Compares the success of a limited term of treatment in the Cincinnati Department of Veterans Affairs Medical Lipid Clinic with that of standard physician-based care in the General Internal Medicine Clinic. Use of the National Cholesterol Education Program I goals for low-density lipoprotein cholesterol; Collaborative practice as an efficacious model of preventive medicine.

Presents a study on the efficacy and safety of pravastatin in African Americans with primary hypercholesterolemia. Pravastatin as an effective and safe lipid-lowering agent; Decline in low density lipoprotein cholesterol levels; Primary hypercholesterolemia. INSET: Patients and methods..

Tests the efficacy of low-dose cholesterol-lowering drug therapy in patients with moderate hypercholesterolemia. Effectiveness of regimen used in primary prevention of coronary heart disease; Reduction in low-density lipoprotein (LDL) cholesterol levels; Potency of combination therapy for LDL cholesterol lowering.

Compares lovastatin and gemfibrozil therapy for effects on lipid and lipoprotein levels in normolipedemic patients with reduced high-density lipoproteins cholesterol levels. Role of lovastatin in reducing total and low-density lipoprotein cholesterol and apolipoprotein B levels; Claim that lovastatin retards the progression of atherosclerosis in patients with documented and clinically significant coronary atherosclerosis.

Discusses the treatment of hypercholesterolemia. Evidence of the need to lower cholesterol levels to decrease the risk of coronary artery disease; Guidelines for treatment; Medications used for lowering cholesterol levels.

A letter to the editor is presented in response to the article "Cost-Effectiveness of PCSK9 Inhibitor Therapy in Patients With Heterozygous Familial Hypercholesterolemia or Atherosclerotic Cardiovascular Disease" by Dhruv S. Kazi in a 2016 issue.

A letter to the editor is presented in response to the article "Deciphering Cholesterol Treatment Guidelines: A Clinician's Perspective," by O. P. Ganda that was published in a 2015 issue.

The author comments on the cholesterol treatment guidelines published by the American College of Cardiology and the American Heart Association (ACC/AHA). He notes the criticism received by the guidelines which was based on 2 issues, eliminating numerical targets for low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) and debate about the value of new pooled risk calculator for treatment initiation decisions.

A response by Dhruv S. Kazi et al. to a letter to the editor about their article "Cost-Effectiveness of PCSK9 Inhibitor Therapy in Patients With Heterozygous Familial Hypercholesterolemia or Atherosclerotic Cardiovascular Disease" in a 2016 issue is presented.

The authors comment on the 2013 guidelines of the American College of Cardiology (ACC) and the American Heart Association (AHA) on the treatment of blood cholesterol. They discuss the thresholds for initiating treatment, the efficacy and safety of various cholesterol-lowering drugs as well as the latest evidence-based methods. They also describe the history and evolution of the guidelines.

A response by Om P. Ganda to a letter to the editor about his article "Deciphering Cholesterol Treatment Guidelines: A Clinician's Perspective" that was published in a 2015 issue is presented.

The article present the National Health and Nutrition Examination Survey, which showed that 27.9% of adults at least 40 years of age are taking cholesterol-lowering medication in 2011-2012, up from 19.9% in 2003-2004. Among the leading cholesterol drug used are simvastatin, atorvastatin, and pravastatin. The patients who take the cholesterol drugs are those with cardiovascular disease (CVD), diabetes, and hypercholesterolemia.

Editorial. Questions when patients with heterozygous familial hypercholesterolemia, one of the most common genetic disease as of January 1999, should be treated. Details about a study by E.A. Stein et al in the same issue of the `Journal of the American Medical Association (JAMA); Suggestion that there is little reason to expect that the cholesterol-lowering efficacy of the statin drugs is less in children than in adults.

Editorial. Discusses the side effects of immediate-release and sustained-release niacin preparation in treating hypercholesterolemia. Complaints of adverse drug reactions; Interpretation of abnormal findings on liver function tests.

Editorial. References a study by Schrott et al in the same issue which describes the extent to which lipid abnormalities are treated in women. Question of whether the study describes a phenomenon biased against women or if it reflects an overall state of nontreatment or undertreatment of hypercholesterolemia in coronary heart disease (CHD) patients of either sex; Evidence to suggest that women with hypercholesterolemia and CHD should be treated as aggressively as men.

Presents a letter to the editor commenting on Blum and Levy's article of current approaches to evaluation and treatment of hypercholesterolemia, published in the 'Journal of the American Medical Association'.

Presents an abstract of a study which examines the safety and efficacy of lovastatin in treating hypercholesterolemia. Methods; Outcome measures; Results and conclusions.

Presents a letter to the editor in response to a series of articles about therapy for low high-density lipoprotein cholesterol.

Presents a letter to the editor responding to commentaries on the authors' article on evaluation and treatment of hypercholesterolemia, published in the 'Journal of the American Medical Association'.

Presents a letter to the editor commenting on the article by Blum and Levy, which indicated that cholestyramine and colestipol are insoluble powders that lower cholesterol levels by interrupting the enterohepatic circulation of bile acids,' published in the 'Journal of the American Medical Association'.

Discusses whether diet or drug therapy is suitable for familial hypercholesteremia. Case of a 64-year-old woman; Cholesterol level; Diseases in the family; Findings after physical examination; Effects of the drugs cholestyramine, nicotinic acid and lovastatin.