Lipid Fractions and Survival in Older Men—Reply

In reply

When assessing causal relations with blood lipids in epidemiological studies, the analysis of an aggregate of all causes will always be less informative than any cause-specific analysis. A meta-analysis of randomized trials of cholesterol-lowering statin therapy in patients 75 years or older demonstrated substantial reductions in the incidence of heart disease and stroke with no adverse effects on nonvascular causes of death.¹ While treatment decisions should be guided principally by the evidence from randomized trials, we have demonstrated that differences in low-density lipoprotein cholesterol levels that are achievable by statin therapy may be associated with a one-third lower risk of heart disease at all ages.² These results suggest that older people with or without established disease are likely to benefit from strategies to lower low-density lipoprotein cholesterol levels, including statin therapy.