Dying of old age


By Dr. John Ditraglia



As we get older our risks of disease and dying go up. We also wind up being medicated for more and more things until we have to take a bag of different medications that can each have side effects and an ever increasing likelihood of deleterious interactions among that increasing quantity of different medications.

In the particular case of treating high cholesterol levels the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines on the management of blood cholesterol recommended in 2018 that “In adults 75 years of age or older with an LDL of 70 to 189 mg/dl, initiating a moderate-intensity statin may be reasonable.” Since virtually all adults older than 75 years have an LDL cholesterol level higher than 70 mg/dl, the traditional cutoff level for treatment with drugs, these guidelines could be interpreted as meaning that we need to treat all of us. Age becomes the dominating risk factor in scoring as the years advance.

But the wording of these guidelines could also mean that “not initiating” this treatment may also be reasonable. What about older than 65 or 85 years? Also these LDL levels are much higher than the levels for which treatment is recommended for younger people. And the evidence for benefit gets slimmer and slimmer or disappears or becomes an actual detriment in some studies. For the most part there just isn’t any good evidence one way or the other. The main job of geriatricians, doctors who specialize in treating old people, is taking their patients off drugs.

Eventually we all will reach the point in life where we can be like small children again and be cured of everything and not have to take medicine or get CT scans anymore. That ends this strange eventful history, Is second childishness and mere oblivion, Sans teeth, sans eyes, sans taste, sans everything.

1. Skolnick N. Reexamining recommendations for treatment of hypercholesterolemia in older adults. JAMA April2, 2019;321(13):1249-50.

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By Dr. John Ditraglia