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May 3, 1995

Cholesterol and Coronary Heart Disease Risk in Elderly Patients-Reply

Author Affiliations

University of California, San Francisco

JAMA. 1995;273(17):1331. doi:10.1001/jama.1995.03520410023012

In Reply.  —Dr Harris and colleagues note that "busy practitioners" may be "left with the impression that lipoprotein lipids are not risk factors for older people." This would be rational, since this is the empirical observation. We do agree with Harris et al that the paradoxical inverse association between blood cholesterol and mortality, which extends to the upper half of the cholesterol distribution in the elderly,1 may not be causal. Their hypothesis that this association would go the other way were it not for an interaction with prior health status is intriguing, but only one of the possible explanations, only partly supported in their own studies,2 and still to be examined elsewhere.Two other issues raised by Harris et al deserve comment. One is their use of the LaRosa et al reference, from which they concluded that lipid treatment is not hazardous in the elderly. That was a

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