a special program of the National Emergency Medicine Association (NEMA)
Week: 526.3 Guest: Dr. Michael Miller, Univ. Of Maryland Medical School Topic: Managing Cholesterol & High Blood Pressure in the Elderly- One Part Host: Steve Girard Producer: Ed Graham
NEMA: We're with Dr. Michael Miller, Director of Preventive Cardiology at the University of Maryland Medical School.... managing cholesterol levels is just as important for the elderly as anyone else, isn't it.....
MILLER: High cholesterol will cause a similar complication in the elderly as it would in younger people...and that complication is it increases the risk for blockages in the heart arteries. And its really those blockages in the heart arteries that occur over time that increase the risk for the development of a heart attack.
NEMA: Some elderly people might believe it doesn't matter if they limit their cholesterol level....
MILLER: In some people that have heart disease, there have been studies that have now demonstrated that even in the elderly with high cholesterol, in whom heart disease is already present, that lowering their cholesterol level with diet and medication tends to reduce the risk of having a heart attack. So, that's new and very useful and exciting information. We know less about people who have high cholesterol, who are elderly and don't have heart disease. And no studies have really been done to examine this portion of the population, and in fact....my grandfather , who God bless him, is 87 years old, has a mild elevation of his cholesterol and I took him off his cholesterol lowering medication because there is really no good data to support. Somebody who has reached his or her 80's or 90's...if they've have no heart disease, then they may have the protective genes. While people who do have heart disease certainly deserve to be treated aggressively, the information in people who are elderly, but do not have heart disease, remains uncertain whether or not medication should be used.
NEMA: Blood pressure management is especially important for the elderly.....
MILLER: I think its estimated that up to three out of every four over the age of 75 have some evidence of high blood pressure. It used to be thought that you could have either elevation in the top number ...the systolic blood pressure, as a concern, versus having the bottom number, the diastolic blood pressure being elevated, as a concern...we know now having either the top number or the bottom number....both increase the risk of having a heart attack or stroke. And we also know from recent studies that lowering the blood pressure in the elderly has an impact on reducing the risk of having a cardio-vascular event, therefore, we try to get the top number below 140, and the bottom number to somewhere below 90...somewhere about 80 to 85 is what we're shooting for.
NEMA: Isn't it true that proper care of diabetes can actually help the heart?
MILLER: Up to one out of five elderly patients over the age of 80 has diabetes. Some of the factors that increase blood sugar include: weight... a lot of patients have a combination of these risk factors...that is, an elderly patient may be overweight, and simply by losing weight, would improve the blood sugar...would improve blood pressure, would lower the blood fats...may elevate the level of the good cholesterol, so, simple kinds of risk factor reduction methods may have substantial dividends...and these are often overlooked because the patient just wants the quick fix and just want to take a medication.
NEMA: Our thanks to Dr. Michael Miller...we'll soon talk with him again on the subject of watching out for drug interactions in the elderly. I'm Steve Girard.