Hypercholesterolemia is known to be associated with a higher risk of coronary events. Although some data exist regarding the efficacy of lipid-lowering drugs and their side effects, no studies have assessed the impact of lipid-lowering therapy on the health-related quality of life of older people. Santanello and colleagues review the results of the Cholesterol Reduction in Seniors Program (CRISP) Pilot Study to determine the effect of lovastatin therapy on health-related quality-of-life measures in older patients.
The CRISP study was a randomized, double-blind trial with three treatment arms. A total of 431 patients participated in the study. Patients received the National Cholesterol Education Program step-one diet plus either placebo or lovastatin in a dosage of 20 or 40 mg per day. Patients included in the study were at least 65 years of age and had low-density lipoprotein (LDL) cholesterol levels between 159 mg per dL (4.0 mmol per L) and 221 mg per dL (5.5 mmol per L). Patients with high triglyceride levels, recent cardiovascular disease and uncontrolled hypertension and an inability to score at least 24 on the Folstein Mini-Mental State Examination were excluded from the study. Patients were followed for at least six months. Quality of life was assessed using a variety of scales that measured physical function, sleep, depression, social support, cognitive ability and health perception.
Lovastatin in a daily dosage of 20 or 40 mg caused a significant decrease in total and LDL cholesterol levels. Patients treated with 20 mg of lovastatin had a 17 percent and 24 percent reduction in total cholesterol and LDL cholesterol levels, respectively; patients receiving 40 mg of lovastatin had reductions of 20 percent and 28 percent, respectively. The only side effect that was more common in the groups receiving lovastatin was abdominal complaints. There were no significant problems with alanine aminotransferase levels, vision changes or myopathy among the three groups. There was also no significant difference in the mean change in scores from baseline in quality-of-life measures, including physical functioning and self-care.
The authors conclude that lovastatin therapy in older persons with elevated LDL cholesterol levels caused no significant adverse symptoms and no changes in quality of life, and was well tolerated. Future studies that assess the long-term use of lovastatin therapy and the reduction in cardiac events in older adults are needed.
COPYRIGHT 1997 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group
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