Cholesterol and Coronary Heart Disease Risk in Elderly Patients

To the Editor.  —In an article in the November 2,1994, issue of The Journal, Dr Krumholz and colleagues¹ prospectively followed 997 elderly subjects and reported no significant relationship between total cholesterol or high-density lipoprotein cholesterol (HDL-C) and cardiac events. Because the wide confidence intervals (CIs) included values greater than 1.0, this cannot be considered a negative study. In fact, the upper limit of their CI for adjusted CHD mortality for men and women (1.98) is a similar risk ratio to that reported previously in middle-aged men.²Part of the reason for the wide CIs is likely the size of the study and short duration of follow-up. Studies establishing the relationship between hypercholesterolemia and CHD in middle-aged individuals evaluated many more subjects for greater lengths of time. For example, the Multiple Risk Factor Intervention Trial³ (MRFIT) followed 356222 subjects over a 6-year period, and the Lipid Research Clinics