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Drug Therapy of Dyslipidemia in the Elderly
Srikanth Yandrapalli1, Shashvat Gupta2, Gabriela Andries2
1Cardiology Division, Westchester Medical Center and New York Medical College, Macy Pavilion, Room 141, Valhalla, NY, 10595, USA.
Insights
Statins offer significant benefits for preventing atherosclerotic cardiovascular disease (ASCVD) in older adults. Shared decision-making is crucial for primary prevention, considering individual health factors and potential risks.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Abnormal lipoprotein metabolism is a key modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD).
- Cardiovascular disease (CVD) is a leading cause of global mortality, making dyslipidemia management critical for risk reduction.
- The aging population necessitates careful consideration of drug therapies, particularly for the elderly.
Purpose of the Study:
- To evaluate the role of statins in primary prevention of ASCVD in individuals over 75 years of age.
- To advocate for shared decision-making in prescribing statins for primary prevention in the elderly.
- To explore combination therapies for optimizing ASCVD risk reduction in older adults.
Main Methods:
- Review of existing studies on statin efficacy for primary and secondary ASCVD prevention.
- Analysis of age-related factors influencing statin benefit-risk ratio, including polypharmacy and frailty.
- Consideration of competing risks of mortality in the elderly population.
Main Results:
- Statins demonstrate clear benefits in secondary ASCVD prevention across all age groups.
- The benefit of statins for primary prevention in individuals over 75 remains a subject of debate.
- Shared decision-making, considering individual health, is recommended for primary statin use in the elderly.
Conclusions:
- Statins should be considered for primary ASCVD prevention in older individuals through shared decision-making.
- Polypharmacy, frailty, and competing risks must be evaluated when prescribing statins to the very old.
- Future research should focus on optimal dyslipidemia therapies, including combination treatments, for the elderly population.
Abstract:
Abnormal lipoprotein metabolism is an important and modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD), which has been shown in numerous studies to lead to adverse cardiovascular outcomes. As cardiovascular disease (CVD) remains the major cause of morbidity and mortality globally, management of dyslipidemia is a key component of primary and secondary risk-reduction strategies. Because ASCVD risk increases with age, as the population ages, many more people-particularly the elderly-will meet guideline criteria for drug treatment. Statins (HMG-CoA reductase inhibitors) have an unequivocal benefit in reducing ASCVD risk across age groups for secondary prevention. However, the benefit of these drugs for primary prevention in those > 75 years of age remains controversial. We strongly believe that statins should be offered for primary prevention to all older individuals after a shared decision-making process that takes polypharmacy, frailty, and potential adverse effects into consideration. When considering statin therapy in the very old, competing risks of death, and therefore the likelihood that patients will live long enough to benefit from drug therapy, should inform this process. Combination therapies with ezetimibe or proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors should be considered to facilitate the use of tolerable doses of statins. Future investigations of dyslipidemia therapies must appropriately include this at-risk population to identify optimal drugs and drug combinations that have a high benefit:risk ratio for the prevention of ASCVD in the elderly.
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