Numerous studies have shown that therapy of hypercholesterolemia in high-risk persons by statins decreases cardiovascular morbidity and mortality in elderly persons.^1-13 The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (NCEP III) guidelines recommend that the serum low-density lipoprotein (LDL) cholesterol be reduced to less than 100 mg/dL in persons with coronary heart disease (CHD), other clinical forms of atherosclerotic vascular disease, diabetes mellitus, the metabolic syndrome, and with multiple risk factors that confer a 10-year risk for CHD of more than 20%, regardless of age.¹⁴ Persons with 2 or more risk factors and a 10-year risk for CAD of 10% to 20% should have their LDL-cholesterol reduced to below 130 mg/dL.¹⁴ Because of data published since these guidelines were formulated, this author recommends that these guidelines be

This article is the second in a three-part series. Part I appeared in the September issue of the Journal.

Alzheimer’s disease (AD) is a bad thing. Nearly everyone would like a treatment that would cure or prevent AD. As of 2004, we do not have such a treatment available.

A case of persistent delirium in a patient with dementia is presented. The delirium persisted despite correction of lithium toxicity and multiple other potential contributing factors. The delirium resolved rapidly with initiation of risperidone. Delirium may represent dysfunction of certain brain regions (prefrontal cortex, thalamus, basal ganglia, right temporoparietal cortex, and fusiform and lingual gyrus) and neurotransmitter systems (dopaminergic, cholinergic, opiatergic, serotonergic, GABAergic, and glutamatergic systems).1 There is an abundance of evidence in the literature that elevated dopaminergic and reduced cholinergic activity likely represents the final common pathway in pathophysiology of delirium.1 This final common pathway represents the target for pharmacologic interventions in delirium. A possible mechanism in the case presented may involve rebalancing of dopaminergic and cholinergic neurotransmitter systems due to relatively greater D2 receptor blockage by risperido

In July 2004, the National Heart, Lung, and Blood Institute, in collaboration with the American College of Cardiology and the American Heart Association, released an update to the 2001 National Cholesterol Education Program Adult Treatment Panel III Guidelines for the management of lipid disorders in adults.¹ This update, based on the results of 5 major trials completed since the 2001 guidelines were published,^2-6 suggests that persons at moderate or high risk for cardiovascular events, including patients with established vascular disease, diabetes, or multiple other risk factors, may benefit from a more aggressive approach to reducing LDL-cholesterol levels (Table).¹

Advocating medicare policies to strengthen care.