To the Editor.
—The lack of association between cholesterol and mortality in very elderly subjects reported by Dr Krumholz and colleagues1 justifies circumspection in the management of hyperlipidemia in this group. However, the mean age of subjects within cholesterol tertiles was not disclosed. Even if age were comparable across tertiles, the extreme influence of age on mortality might require a larger sample or longer follow-up to detect outcome differences attributable to cholesterol.Information on prior screening of subjects was not provided. These subjects must fall, prima facie, into one of the following three groups: (1) those not previously screened for cholesterol, (2) those previously found to have low or normal cholesterol, or (3) those previously found to have elevated cholesterol. Subjects not screened prior to old age may not represent the general public and may simply be resistant to hypercholesterolemia, albeit over an unspecified period of time. Subjects previously
Katz DL. Cholesterol and Coronary Heart Disease Risk in Elderly Patients. JAMA. 1995;273(17):1329-1330. doi:10.1001/jama.1995.03520410023009