Letters to the Editor

Hyperlipidemia in Older Adults

To the Editor,

Given the perplexity of choice, I would like to know if non–high-density lipoprotein (HDL) or APO-B have a role in risk assessment of hyperlipidemia in older adults.

Dr. Frank M. Shanley, FACC
Denville, NJ

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Drs. Arnold and Rich respond:

Thank you for your interest in our article.1 Low apolipoprotein A-1 and high apolipoprotein B levels have been shown to be more effective than low-density lipoprotein (LDL) cholesterol levels in predicting myocardial infarction (MI) in some but not all studies involving older adults.2,3 In the Apolipoprotein

Treating Systemic Hypertension in Older Persons

To the Editor:

I have several comments about the article by Drs. Aronow and Frishman, both distinguished cardiologists, on “Treating Systemic Hypertension in Older Persons.”1 There is no question that hypertension, particularly systolic hypertension, is a common problem in the elderly and should be treated, but at what level and to what goal? The authors state that “We agree with the recommendations of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7), that the goal of treatment of hypertension in elderly persons is to

Electroconvulsive Therapy: When Stigma Delays Use of an Effective Treatment

To the Editor:

I am writing regarding Dr. Lantz’s article from the December 2008 issue of Clinical Geriatrics.1 As a highly experienced psychiatrist who has performed thousands of electroconvulsive therapies (ECTs), I take exception to your sweeping statements which suggest to the uninitiated that ECT will be ineffective if the patient is taking a benzodiazepine or an anticonvulsant. Your heading for Table II is more accurate. It is misleading to say in the body of the table that those types of medications “will” interfere. In fact, ECT can often be effective in spite of such m

What Is Medicare Going to Do to Survive?

To the Editor:

I applaud and concur with Dr. Stefanacci’s article on the survival of Medicare.1 Clearly, reallocation and prioritizing will be needed, and the sooner the better. Missing from the article was address of the astronomical dollars spent on the last three months of life; this must be rethought and hospice offered for the frail elderly if basic care does not work. Secondly, I believe there should be real choice offered in senior plans such as a Palliative Care Plan that offers “basic” medical care with care coordination, therapy, etc., but also some home help for elde

Pulmonary Embolus— Unusual Presentations and Diagnostic Dilemma

To the Editor:

Thank you for your report of a pulmonary embolism case in the October 2008 issue of Clinical Geriatrics.1 I’ll bet we are all missing lots of pulmonary emboli (PEs). I wonder what to do with all of my patients who are immobilized from old strokes or multiple sclerosis. Should they be on prophylactic anticoagulation chronically? I’ll keep your case in mind. You also taught me about McConnell’s sign. If the case patient didn’t have contraindications, I’m sure she may have been offered tissue plasminogen activator because of this sign, despite her