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Serum cholesterol and the aging process
Medical
Hypotheses
SEFUJM CHOLESTEXJL
7:
685-694,
1981
AND THE AGING PROCESS
W. McIBnagh,C. J. Rudolph and E. Cheraskin,McDonagh Medical Center, 2800-A KendallwoodParkway,Gladstone,Missouri 64119, U. S. A.
E.
ABSTPACI With advancingage, the average serum cholesterollevel rises. Thus, older persons generallyhave higher cholesterolscores than do younger individuals. Quite apart, it is a generallyagreed fact that older persons die more readily than younger people. Finally, there is general agreement that older persons with higher cholesterollevels die rmre readily,though not necessarilyof cardiovasculardisease,than older people without hvcercholesterolemia. It then follows that, all other factorsbeinq equal, lawering hypercholesterolemia is, in fact, an expressionof "makingoeople younger". Two hundred and twenty-oneroutine private practicepatientswere studied before and after approximatelytwo mnths of routine therapy including IDTA treatmentand general supoortivecare includingmltivitamintrace mineral supplementation. The evidence indicates,within the limits of this kind of study conductedin a private practiceenvironnent,that favorablechanges occurred in serum cholesterollevels suggestinga wssible reversalof the aging process.
To many health practitioners,with advancingage, there is an increase in blood cholesterol. Thus, moving from left to right on the x-axis (Figure l), one gets older and this is paralleledby a rise in blood cholesterol (Figure1) on the y-axis. The principaljustificationfor this hypothesis is siaply that, as people get older, they do indeed generallydisplay higher cholesterolscores. The obvious conclusionfran this philosophyis that it is physiologicwith advancingage to display advancingserum cholesterol scores. This is clearly a serious oversisplification of the relationshipsince it is obvious that there are, in fact, scms elderly persons with lower cholesterol levels than other younger subjects. Hence, a scmewhatrmre accurate representation(Fic2) shcms the average blood cholesterol (on the vertical axis) rising with age (on the horizontalaxis). However, the surrounding gray zone recognizesthat, with advancingage, there is also a progressive increase invariance.
Actually, this is still not quite cmsistent with the clinical facts. True, with increasingage, the average cholesterolrises (Z& in Figure 1). 685
4 increased serum cholesterol
advancing age I) Figure 1. The am-only held philosophythat, with advancing age (frcmleft to right on t!e abscissa),there is an increasein serum cholesterol (movingupward on the ordinate). True, with advancingage, the variame also increases (as in Figure 2). Howwer, there comes apointwherethemaan andthe varianceplateau (Figure 3) because the extremas (thevery high hypercholesteremics and the very law hypocholesteremics) have died! REVIEWOFTHELITERATURE --Wynder and Hill (11, aware of the continuingscientificand medical debate (2, 3, 4, 5, 6, 7, 8) over what constitutesnom1 serum cholesterol, conducteda survey of investigatorsmwo in the fieldof atherosclerosis. -TPSpecifically,they circulateda questionnairewhich read as follows: Recently therehas baenconsiderabledebate about the "norsal"cholesterollevel by the lay press and by authoritiesin the field of CHD. I amtrying to poll key investigatorsas to what the normal cholesterollevels by age in man and manen should be. By normal I would define that level that would satisfy the body's need for cholesterolwithout causing adverse reactions. As these investigatorsreport, the answerswere representativeof clinicians,pathologists,epidemiologists,and basic researchers. lhirty-
686
4 increased serum cholesterol
advancing age I) Figure 2. A less commonlyheld philosophythat, on the average,with advancingage (depictedfrom left to right on the x-axis),there is an increasein serum (movingup_ ward on the y-axis). Hover, the increasingvariance with tin-e(the gray area surroundingthe mean scores), increasesindicatingthat scme older persons display lower serum cholesterolvalues than other younger individuals. five replies funnelledin from the United States, Canada, England,Australia, and South Africa. Themeans and the ranges for serum cholesterolwere found to be 146 (loo-2001,174 (140-220),and 185 (150-250)ITKJ% for the 10, 30, and 50 years of age, respectively. It mst be r-has&d that the questionof nonndl serum cholesterol was directed to a group interestedin a particularproblem. It follows that their opinions regardingnormal serum cholesterolstem from their interest in atherosclerosisand related disorders.
Cheraskinand Ringsdorf (9) make the point that biochemicaltests, while often characteristicof certain syndromes,are not pathognomonicof any. In other mrds, it is much more meaningfulto view biochemicalparameters as a measure of the overall syndrorfe of sickness. Accordingly,they
687
4 increased serum cholesterol
advancing age + Figure 3. With advancingage, theman serumcholesterol and the variance (the gray area aboutthenrean) increases. Hcmever,there is apointatwhich theman andvariance flatten because the continuinghypei--and hypocholesteremics havedied. undertookanother approachto the problem of developingthe serum _choles. terol values in a progressivelysyqtomless and signfreegroup. This approach appears reasonablesince the prestrmption can be made that, all other factorsbeing equal, the patient without syn@mms and signs -(relating to arteriosclerosisand nonarteriosclerosis) is probablyhealthierthan one with clinical findings. The conditionsof 1281 doctors and their spouseswere evaluated (10) in terms of the nonfastingserum cholesterol (by an autmted enzyme systernof chemical analysis). Clinicalstatewas graded by the Cornell Malical Index Health Questionnaire(CNI). The CMI is a self-administered test consistingof 195 questims. Each question is answeredby circlingthe word "yes" or "no". The questionsare phrased so that the affirmative answers indicatepathologicfindings (clinicalsymptom and signs). The clinical findings in this report are the total number of affirmativeCNI responses (CPU score). In the accmpanyingTable1, linelshows that1281subjectswith a CMI range frm 0 to 125, a mean CDlIscore of 15.5, a senm cholesterolrange from 110 to 520 rrg%with a man and one standarddeviationof 224244 mg%. Moving downward through the table (lines2, 3, etc.), it is obvious that
688
progressivelyfewer symptonsand sighs are paralleledwith a progressively lower mean cholesterolscore and a narrower range. Thus, in the healthiest group (line 81, the very low and very high cholesterolscores have been eliminatedso that the range has shrunk fmn 110 to 520 (line1) to 176 to 239 (line 8). These differencesare statisticallysignificant. Table1 relationshipof nonfastingserm cholesteroland total clinical findings in a presumablyhealthy male and female sarrp3le
line 1 2 3 4 5 6 7 8
4roup
sample size
entire group CMI <20 0l.I
1281 930 474 157 100 66 23 7
clinical findings (affirmativeCNI* responses) range n~a&.D. O-125 o-19 o-9 o-4 o-3 o-2 o-1 0
15.5tl2.2 9.62 5.0 5.5+ 2.3 2.82 1.2 2.0+ 0.9 1.52 0.7 0.7t 0.5 0.02 0.0
nonfastingserum cholesterollevel, w/a
range
i?ea&.D.
110-520 110-520 122-520 122-456 122-456 158-456 166-290 176-239
224+44 223+44 221247 216241 213+42 21lk43 214+36 207228
*CNI, Cornell Medical Index Health Questionnaire The evidencepresentedhere from a study of Presumablyhealthy doctors and their spouses suggeststhat the ideal nonfastingserum cholesterollevel may approach approximately200 IIKJ% as derived,not frcm a a study of atherosclerosisand related syndromes,but rather from a study of the nonspecific and more encompassingsyndroneof sickness.
Tm hundred and twenty-oneroutine patientswere studied in a general practice environmnt. The age and sex distributionis smmarized (Table2). After a careful initial clinicalexamination,a battery of biochemicaltests and other diagnosticprocedureswere performed. Includedwas a nonfasting serum cholesterolby an enzymaticprocedure (11, 12). FollowingEDNA therapy, with supportivemltivitamin-tracemineral supplemmtation describedrare fully in another experimant (13) for a period of approximately30-60 days, the serum cholesterolwas redetermined. The initialversus subsequentserum cholesterolwas calculated,based upon age by dividing the entire sample of 221 subjects into five near-equalsubgroupsaccordingto age.
689
Table 2 age and sex distribution age groups 20-29 30-39 40-49 50-59 60-69 70-79 80-89 totals n~a.n & SD.
minimum ltEucimum range
male group 1 6 11 35 36 17 6 112
fmale group
( 0.9%) ( 5.4%) ( 9.8%) ( 31.3%) ( 32.1%) ( 15.1%) ( 5.4%) (100.0%)
1 3 15 26 29 31 4 109
59.9i12.0
total group
( 0.9%) ( 2.7%) ( 13.8%) ( 23.9%) ( 26.6%) ( 28.4%) (
2 9 26 61 65 48 10 221
3.7%)
(100.0%)
62.0f11.9
26 84 58
( 0.9%) ( 4.1%) ( 11.8%) ( 27.6%) ( 29.4%) ( 21.78) ( 4.5%) (100.0%)
60.9f12.0
23 84 61
23 84 61
REZXJLTS Table 3 sursrar izes the total information. Several mints are wcrthv of special mention. First, it is clear that, at the initialexamination, the serum cholesterolvalues rise with age up to a point (line 4). Figure 4 graphicallydepicts the pattern. In the youngest four age groups (23-51, 52-58, 59-64, 65-71 years), the man serum cholesterolvalues rise slowly (72-84years) (237,242, 245, and 249 mg%). Only in the very oldest gro~~p does the man serum cholesterolplateau. After a period of 42 to 62 days (Table3, line 5) in the various age groups, the mean serum cholesterol Table 3 the relationshipof serum cholesterolwith age initiallyand followingtreatmentin a private practicemedical environment line age groups 23-51 sample size 43 man age 43.026.9 initial serum cholesterol 237+64 time between 1st L 2nd cholesterol (days) 62 secondserum cholesterol 208257
age groups (years) 52-58 46 55.122.1
59-64 45 61.721.7
65-71 42 68.321.9
72-84 45 76.453.6
242+55
245257
249253
240248
48
62
53
42
211247
690
214+-51
220+_43
215+44
the relatronship of age and serum cholesterol before and after EDTA therapy
240
initial mean serum cholesterolscores
mean cholesterol scores
(mg%) 220
2l/\o2l. 21;/”
secondmeon serum cholesterol scores
'of/
sample sue
(n-43)
‘J9e 9roups (years)
h=46)
23-51
55
mean8 standard43.0f6.9 deviation of age
Figure 4. At the lesterol
oldest
rise
(n=45)
52-58
I t21
initial
with
age category.
59-64 617fl.7
(r-1=42)
age
72-84
68.3 f 1.9
examination,
advancing
(n-45)
65-71
until
The same obtains
76.4k3.6
the
rwzan serum
the
plateau
choin
the
after
therapy. E&wever, it is clear thak, in every age category,the mean cholesterol
values
are significantly
lawer following
therapy.
values
are again recorded. Once again, with advancingage, the mean cholesterol scores rise (208,211, 214, and 220 rrq%)until the oldest age group notmrthy is that, where there is again a plateau (215w%). What is xtxxzt in all age groups, the average cholesterolscores followingtherapy are significantly lawer than at the initial examination.
DISCUSSION It remains a fact that, in traditionalmedical circles,the serum cholesterolis expected to rise with advancingage. Thus, it is routine to find differentacceptablevalues at differentages. The patternsgenerally acceptableare pictured in Figures 5 (14) and 6 (15)which, it should be recalled,follow the principlesset forth in Figure 1. On theotherhand,our findingsarerroreconsistentwkhthe so-called norms derived by developingthe smtomless and signfreeapproach. It should be recalled that the "ideal"serum cholesterol,at all ages, appears to approach approxkately 200 mg% (Table1). The findin in these patients posttherapy approach 200 rq%.
697
serum cholesterol
levels in a so-called
normal
population 280 0
(n=7830)
...* *...**
260
240
mean serum cholesterol
901
(mgm
220
200 <25
25-34
35-44
45-54
55-64
65+
age groups
from
:
Pincherle,
G.
Factors
affecting
J. Chron. Dis. 24: # 5,289-297,
the mean serum cholesterol. August
1971.
Figure 5. The serum cholesterol patterns in a presumably healthy populationof 7830 individuals. The mnclusion drawn is that it is a physiologic fact that, with advancing age, the mean serum cholesterollevel rises in both sexes. SUMMARY
It is an incontestablefact that, with advancingage, the average cholesterolrises. Older people generallyhave higher cholesterolscores than younger people. It is an incontestablefact that older persons die mre readily than younger people. It is an incontestablefact that older persons with higher cholesterollevels die mre readily though not necessarily of cardiovasculardisease than older people without hypercholesterolemia.
It then follows that, all other factors being equal, loweringhyperis, in fact, an expression of "makingpeople younger".
cholesterolemia
TW hundred and twenty-oneroutine private practicepatientswere studiedbefore and after approximatelytm mnths of routine therapy including EDTAtreatmntandgeneralsuppcrtive care includingmultivitamintrace mineral supplemsntation. The evidence indicates,within the limits of this kind of study conducted in a private practiceenvironrtent, that favorablechanges occurred in serum cholesterollevels suggestinga possible reversalof the aging process.
692
serum cholesterol
e-e
in 1884 normal subjects”
875 males
O---O 383
284
females
371
-o:_ _.._...2$.....‘Sm’-* ....
mean serum
2r
cholesterol
238~ 231/
(mgm. per cent)
l
2i5.e / ,gg b
* __........0’ /.. ..‘236 ,. 237
-0 ....._..._(*...“’ .....;;2 /**219 ..*.”
217
199 15
20
25
30
35
40 age
HSchillmg,
:2
Amer J Clin. Nutr
50
55
60
65
(years)
F.J.,Christakrs,G.,Orbach.
and triglyceride
45
epidemiological
A. and 8ecker.W.H. and pathogenetic
22 X2,133-138xbruary
Serum cholesterol -interpretation
1969
Figure 6. The serum cholesterolpattems in a presumably healthy populationof 1864 subjects. The conclusiondrawn frm these observationsis that it is a physiologicfact that, with advancingage, the man serum cholesterolscores rise in both sexes. REFERENCES 1. Wynder, EL and Bill, P. Blood Lipids: Bow Normal is Normal? Prevent.Meditine 1: 161, 1972. 2. Walker, ARP. Average, Normal and Desirable.South African Medical J. 51: 327, 1977. 3. Wright, IS. Correct Levels of Serum Cholesterol,Average vs. Normal vs. Optimal.J. American Medical Association236: 261, 1976. 4. Lingdren,FT, Adamon, CL, Jenson, ID, an? wood, PD. Lipid andLipoprotein Measurements in a Normal Adult American Population.Lipids 10: 750, 1975. 5. Casdorph,HR. Normal Limits for Serum Cholesterol.Lancet 1: 1076, 1972. 6. Keys, A. Normal Serum Cholesterol.Geriatrics24: 61, 1969.
693
7. Barnett,BN. Normal Sennn CholesterolLevels. New England 17.Medicine 280: 50, 1969. New mgland J. Medicine 8. Brown, PK. Normal Serum CholesterolLevels.. 280: 49, 1969. 9.
Cheraskin,E and Ringsdorf,w, Jr. PredictiveMedicine:A Study in Strategy.New Canaan, Keats Publishing,Inc. 1977. p. 73.
10. Cheraskin,E and Bingsdorf,W4, Jr. Another I_mk at the "Ideal"Serum CholesterolLevel? Archives InternalbMici_ne 140: 580, 1980. 11. Allain, CC, Poon, LS, Ghan, CSG, Richmmd, W, and Fu, PC. Enzymtic Determinationof Total Serum Cholesterol.Clinical Chemistry20: 240, 1974. 12. Henry, W, Cannon, DC, and Winkelman,JW. ClinicalChemistry:Principles and Techniques.Hagerstown,Harper and Raw, 1974. p. 1436. 13. McDonagh,EW, Rudolph,CJ, and Cheraskin,E. The Effect of Intravenous DiscdiumEthyle.nediaminetetraacetic Acid (EIYIA) upn Blood Cholesterol in a Private Practice Enviromnt. (submittedfor publication) 14. Pincherle,G. Factors Affecting the Mean Serum Cholesterol.J. Chronic Disease 24: 289, 1971. 15. &hilling, FJ, Christakis,G, Orbach, A, and Becker,WH. Serum Cholesterol and Triglyceride:An Epidemiologicaland PathogeneticInterpretation.American J. ClinicalNutrition 22: 133, 1969.
694
Hypotheses
SEFUJM CHOLESTEXJL
7:
685-694,
1981
AND THE AGING PROCESS
W. McIBnagh,C. J. Rudolph and E. Cheraskin,McDonagh Medical Center, 2800-A KendallwoodParkway,Gladstone,Missouri 64119, U. S. A.
E.
ABSTPACI With advancingage, the average serum cholesterollevel rises. Thus, older persons generallyhave higher cholesterolscores than do younger individuals. Quite apart, it is a generallyagreed fact that older persons die more readily than younger people. Finally, there is general agreement that older persons with higher cholesterollevels die rmre readily,though not necessarilyof cardiovasculardisease,than older people without hvcercholesterolemia. It then follows that, all other factorsbeinq equal, lawering hypercholesterolemia is, in fact, an expressionof "makingoeople younger". Two hundred and twenty-oneroutine private practicepatientswere studied before and after approximatelytwo mnths of routine therapy including IDTA treatmentand general supoortivecare includingmltivitamintrace mineral supplementation. The evidence indicates,within the limits of this kind of study conductedin a private practiceenvironnent,that favorablechanges occurred in serum cholesterollevels suggestinga wssible reversalof the aging process.
To many health practitioners,with advancingage, there is an increase in blood cholesterol. Thus, moving from left to right on the x-axis (Figure l), one gets older and this is paralleledby a rise in blood cholesterol (Figure1) on the y-axis. The principaljustificationfor this hypothesis is siaply that, as people get older, they do indeed generallydisplay higher cholesterolscores. The obvious conclusionfran this philosophyis that it is physiologicwith advancingage to display advancingserum cholesterol scores. This is clearly a serious oversisplification of the relationshipsince it is obvious that there are, in fact, scms elderly persons with lower cholesterol levels than other younger subjects. Hence, a scmewhatrmre accurate representation(Fic2) shcms the average blood cholesterol (on the vertical axis) rising with age (on the horizontalaxis). However, the surrounding gray zone recognizesthat, with advancingage, there is also a progressive increase invariance.
Actually, this is still not quite cmsistent with the clinical facts. True, with increasingage, the average cholesterolrises (Z& in Figure 1). 685
4 increased serum cholesterol
advancing age I) Figure 1. The am-only held philosophythat, with advancing age (frcmleft to right on t!e abscissa),there is an increasein serum cholesterol (movingupward on the ordinate). True, with advancingage, the variame also increases (as in Figure 2). Howwer, there comes apointwherethemaan andthe varianceplateau (Figure 3) because the extremas (thevery high hypercholesteremics and the very law hypocholesteremics) have died! REVIEWOFTHELITERATURE --Wynder and Hill (11, aware of the continuingscientificand medical debate (2, 3, 4, 5, 6, 7, 8) over what constitutesnom1 serum cholesterol, conducteda survey of investigatorsmwo in the fieldof atherosclerosis. -TPSpecifically,they circulateda questionnairewhich read as follows: Recently therehas baenconsiderabledebate about the "norsal"cholesterollevel by the lay press and by authoritiesin the field of CHD. I amtrying to poll key investigatorsas to what the normal cholesterollevels by age in man and manen should be. By normal I would define that level that would satisfy the body's need for cholesterolwithout causing adverse reactions. As these investigatorsreport, the answerswere representativeof clinicians,pathologists,epidemiologists,and basic researchers. lhirty-
686
4 increased serum cholesterol
advancing age I) Figure 2. A less commonlyheld philosophythat, on the average,with advancingage (depictedfrom left to right on the x-axis),there is an increasein serum (movingup_ ward on the y-axis). Hover, the increasingvariance with tin-e(the gray area surroundingthe mean scores), increasesindicatingthat scme older persons display lower serum cholesterolvalues than other younger individuals. five replies funnelledin from the United States, Canada, England,Australia, and South Africa. Themeans and the ranges for serum cholesterolwere found to be 146 (loo-2001,174 (140-220),and 185 (150-250)ITKJ% for the 10, 30, and 50 years of age, respectively. It mst be r-has&d that the questionof nonndl serum cholesterol was directed to a group interestedin a particularproblem. It follows that their opinions regardingnormal serum cholesterolstem from their interest in atherosclerosisand related disorders.
Cheraskinand Ringsdorf (9) make the point that biochemicaltests, while often characteristicof certain syndromes,are not pathognomonicof any. In other mrds, it is much more meaningfulto view biochemicalparameters as a measure of the overall syndrorfe of sickness. Accordingly,they
687
4 increased serum cholesterol
advancing age + Figure 3. With advancingage, theman serumcholesterol and the variance (the gray area aboutthenrean) increases. Hcmever,there is apointatwhich theman andvariance flatten because the continuinghypei--and hypocholesteremics havedied. undertookanother approachto the problem of developingthe serum _choles. terol values in a progressivelysyqtomless and signfreegroup. This approach appears reasonablesince the prestrmption can be made that, all other factorsbeing equal, the patient without syn@mms and signs -(relating to arteriosclerosisand nonarteriosclerosis) is probablyhealthierthan one with clinical findings. The conditionsof 1281 doctors and their spouseswere evaluated (10) in terms of the nonfastingserum cholesterol (by an autmted enzyme systernof chemical analysis). Clinicalstatewas graded by the Cornell Malical Index Health Questionnaire(CNI). The CMI is a self-administered test consistingof 195 questims. Each question is answeredby circlingthe word "yes" or "no". The questionsare phrased so that the affirmative answers indicatepathologicfindings (clinicalsymptom and signs). The clinical findings in this report are the total number of affirmativeCNI responses (CPU score). In the accmpanyingTable1, linelshows that1281subjectswith a CMI range frm 0 to 125, a mean CDlIscore of 15.5, a senm cholesterolrange from 110 to 520 rrg%with a man and one standarddeviationof 224244 mg%. Moving downward through the table (lines2, 3, etc.), it is obvious that
688
progressivelyfewer symptonsand sighs are paralleledwith a progressively lower mean cholesterolscore and a narrower range. Thus, in the healthiest group (line 81, the very low and very high cholesterolscores have been eliminatedso that the range has shrunk fmn 110 to 520 (line1) to 176 to 239 (line 8). These differencesare statisticallysignificant. Table1 relationshipof nonfastingserm cholesteroland total clinical findings in a presumablyhealthy male and female sarrp3le
line 1 2 3 4 5 6 7 8
4roup
sample size
entire group CMI <20 0l.I
1281 930 474 157 100 66 23 7
clinical findings (affirmativeCNI* responses) range n~a&.D. O-125 o-19 o-9 o-4 o-3 o-2 o-1 0
15.5tl2.2 9.62 5.0 5.5+ 2.3 2.82 1.2 2.0+ 0.9 1.52 0.7 0.7t 0.5 0.02 0.0
nonfastingserum cholesterollevel, w/a
range
i?ea&.D.
110-520 110-520 122-520 122-456 122-456 158-456 166-290 176-239
224+44 223+44 221247 216241 213+42 21lk43 214+36 207228
*CNI, Cornell Medical Index Health Questionnaire The evidencepresentedhere from a study of Presumablyhealthy doctors and their spouses suggeststhat the ideal nonfastingserum cholesterollevel may approach approximately200 IIKJ% as derived,not frcm a a study of atherosclerosisand related syndromes,but rather from a study of the nonspecific and more encompassingsyndroneof sickness.
Tm hundred and twenty-oneroutine patientswere studied in a general practice environmnt. The age and sex distributionis smmarized (Table2). After a careful initial clinicalexamination,a battery of biochemicaltests and other diagnosticprocedureswere performed. Includedwas a nonfasting serum cholesterolby an enzymaticprocedure (11, 12). FollowingEDNA therapy, with supportivemltivitamin-tracemineral supplemmtation describedrare fully in another experimant (13) for a period of approximately30-60 days, the serum cholesterolwas redetermined. The initialversus subsequentserum cholesterolwas calculated,based upon age by dividing the entire sample of 221 subjects into five near-equalsubgroupsaccordingto age.
689
Table 2 age and sex distribution age groups 20-29 30-39 40-49 50-59 60-69 70-79 80-89 totals n~a.n & SD.
minimum ltEucimum range
male group 1 6 11 35 36 17 6 112
fmale group
( 0.9%) ( 5.4%) ( 9.8%) ( 31.3%) ( 32.1%) ( 15.1%) ( 5.4%) (100.0%)
1 3 15 26 29 31 4 109
59.9i12.0
total group
( 0.9%) ( 2.7%) ( 13.8%) ( 23.9%) ( 26.6%) ( 28.4%) (
2 9 26 61 65 48 10 221
3.7%)
(100.0%)
62.0f11.9
26 84 58
( 0.9%) ( 4.1%) ( 11.8%) ( 27.6%) ( 29.4%) ( 21.78) ( 4.5%) (100.0%)
60.9f12.0
23 84 61
23 84 61
REZXJLTS Table 3 sursrar izes the total information. Several mints are wcrthv of special mention. First, it is clear that, at the initialexamination, the serum cholesterolvalues rise with age up to a point (line 4). Figure 4 graphicallydepicts the pattern. In the youngest four age groups (23-51, 52-58, 59-64, 65-71 years), the man serum cholesterolvalues rise slowly (72-84years) (237,242, 245, and 249 mg%). Only in the very oldest gro~~p does the man serum cholesterolplateau. After a period of 42 to 62 days (Table3, line 5) in the various age groups, the mean serum cholesterol Table 3 the relationshipof serum cholesterolwith age initiallyand followingtreatmentin a private practicemedical environment line age groups 23-51 sample size 43 man age 43.026.9 initial serum cholesterol 237+64 time between 1st L 2nd cholesterol (days) 62 secondserum cholesterol 208257
age groups (years) 52-58 46 55.122.1
59-64 45 61.721.7
65-71 42 68.321.9
72-84 45 76.453.6
242+55
245257
249253
240248
48
62
53
42
211247
690
214+-51
220+_43
215+44
the relatronship of age and serum cholesterol before and after EDTA therapy
240
initial mean serum cholesterolscores
mean cholesterol scores
(mg%) 220
2l/\o2l. 21;/”
secondmeon serum cholesterol scores
'of/
sample sue
(n-43)
‘J9e 9roups (years)
h=46)
23-51
55
mean8 standard43.0f6.9 deviation of age
Figure 4. At the lesterol
oldest
rise
(n=45)
52-58
I t21
initial
with
age category.
59-64 617fl.7
(r-1=42)
age
72-84
68.3 f 1.9
examination,
advancing
(n-45)
65-71
until
The same obtains
76.4k3.6
the
rwzan serum
the
plateau
choin
the
after
therapy. E&wever, it is clear thak, in every age category,the mean cholesterol
values
are significantly
lawer following
therapy.
values
are again recorded. Once again, with advancingage, the mean cholesterol scores rise (208,211, 214, and 220 rrq%)until the oldest age group notmrthy is that, where there is again a plateau (215w%). What is xtxxzt in all age groups, the average cholesterolscores followingtherapy are significantly lawer than at the initial examination.
DISCUSSION It remains a fact that, in traditionalmedical circles,the serum cholesterolis expected to rise with advancingage. Thus, it is routine to find differentacceptablevalues at differentages. The patternsgenerally acceptableare pictured in Figures 5 (14) and 6 (15)which, it should be recalled,follow the principlesset forth in Figure 1. On theotherhand,our findingsarerroreconsistentwkhthe so-called norms derived by developingthe smtomless and signfreeapproach. It should be recalled that the "ideal"serum cholesterol,at all ages, appears to approach approxkately 200 mg% (Table1). The findin in these patients posttherapy approach 200 rq%.
697
serum cholesterol
levels in a so-called
normal
population 280 0
(n=7830)
...* *...**
260
240
mean serum cholesterol
901
(mgm
220
200 <25
25-34
35-44
45-54
55-64
65+
age groups
from
:
Pincherle,
G.
Factors
affecting
J. Chron. Dis. 24: # 5,289-297,
the mean serum cholesterol. August
1971.
Figure 5. The serum cholesterol patterns in a presumably healthy populationof 7830 individuals. The mnclusion drawn is that it is a physiologic fact that, with advancing age, the mean serum cholesterollevel rises in both sexes. SUMMARY
It is an incontestablefact that, with advancingage, the average cholesterolrises. Older people generallyhave higher cholesterolscores than younger people. It is an incontestablefact that older persons die mre readily than younger people. It is an incontestablefact that older persons with higher cholesterollevels die mre readily though not necessarily of cardiovasculardisease than older people without hypercholesterolemia.
It then follows that, all other factors being equal, loweringhyperis, in fact, an expression of "makingpeople younger".
cholesterolemia
TW hundred and twenty-oneroutine private practicepatientswere studiedbefore and after approximatelytm mnths of routine therapy including EDTAtreatmntandgeneralsuppcrtive care includingmultivitamintrace mineral supplemsntation. The evidence indicates,within the limits of this kind of study conducted in a private practiceenvironrtent, that favorablechanges occurred in serum cholesterollevels suggestinga possible reversalof the aging process.
692
serum cholesterol
e-e
in 1884 normal subjects”
875 males
O---O 383
284
females
371
-o:_ _.._...2$.....‘Sm’-* ....
mean serum
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epidemiological
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22 X2,133-138xbruary
Serum cholesterol -interpretation
1969
Figure 6. The serum cholesterolpattems in a presumably healthy populationof 1864 subjects. The conclusiondrawn frm these observationsis that it is a physiologicfact that, with advancingage, the man serum cholesterolscores rise in both sexes. REFERENCES 1. Wynder, EL and Bill, P. Blood Lipids: Bow Normal is Normal? Prevent.Meditine 1: 161, 1972. 2. Walker, ARP. Average, Normal and Desirable.South African Medical J. 51: 327, 1977. 3. Wright, IS. Correct Levels of Serum Cholesterol,Average vs. Normal vs. Optimal.J. American Medical Association236: 261, 1976. 4. Lingdren,FT, Adamon, CL, Jenson, ID, an? wood, PD. Lipid andLipoprotein Measurements in a Normal Adult American Population.Lipids 10: 750, 1975. 5. Casdorph,HR. Normal Limits for Serum Cholesterol.Lancet 1: 1076, 1972. 6. Keys, A. Normal Serum Cholesterol.Geriatrics24: 61, 1969.
693
7. Barnett,BN. Normal Sennn CholesterolLevels. New England 17.Medicine 280: 50, 1969. New mgland J. Medicine 8. Brown, PK. Normal Serum CholesterolLevels.. 280: 49, 1969. 9.
Cheraskin,E and Ringsdorf,w, Jr. PredictiveMedicine:A Study in Strategy.New Canaan, Keats Publishing,Inc. 1977. p. 73.
10. Cheraskin,E and Bingsdorf,W4, Jr. Another I_mk at the "Ideal"Serum CholesterolLevel? Archives InternalbMici_ne 140: 580, 1980. 11. Allain, CC, Poon, LS, Ghan, CSG, Richmmd, W, and Fu, PC. Enzymtic Determinationof Total Serum Cholesterol.Clinical Chemistry20: 240, 1974. 12. Henry, W, Cannon, DC, and Winkelman,JW. ClinicalChemistry:Principles and Techniques.Hagerstown,Harper and Raw, 1974. p. 1436. 13. McDonagh,EW, Rudolph,CJ, and Cheraskin,E. The Effect of Intravenous DiscdiumEthyle.nediaminetetraacetic Acid (EIYIA) upn Blood Cholesterol in a Private Practice Enviromnt. (submittedfor publication) 14. Pincherle,G. Factors Affecting the Mean Serum Cholesterol.J. Chronic Disease 24: 289, 1971. 15. &hilling, FJ, Christakis,G, Orbach, A, and Becker,WH. Serum Cholesterol and Triglyceride:An Epidemiologicaland PathogeneticInterpretation.American J. ClinicalNutrition 22: 133, 1969.
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