Treatment of hypercholesterolaemia in older adults calls for a patient-centred approach

Area of Science:

• Gerontology
• Cardiology
• Pharmacology

Background:

• Increasing prevalence of cardiovascular disease (CVD) risk factors in older adults necessitates re-evaluation of lipid-lowering therapy eligibility.
• Heterogeneity in health and functional status among older adults complicates traditional risk assessment for cardiovascular events.
• Current guidelines may not adequately address the nuanced benefits and harms of lipid-lowering drugs in elderly populations with comorbidities.

Purpose of the Study:

• To propose a shift in hypercholesterolemia treatment decisions for adults aged 75 years and older.
• To advocate for a patient-centered, lifetime benefit-based approach over a strict 10-year cardiovascular risk-driven strategy.
• To integrate frailty, safety concerns, and life expectancy into risk-benefit discussions for lipid-lowering therapy.

Main Methods:

• Utilizing a competing risk-adjusted, older adult-specific risk score from u-prevent.com.
• Incorporating patient's cardiovascular health profile (cholesterol, renal function) into risk estimation.
• Modeling the effect of lipid-lowering medication on absolute risk reduction for individual patients.

Main Results:

• Traditional risk tools may overestimate CVD risk in older adults.
• The proposed approach provides more detailed guidance on initiating or deprescribing lipid-lowering therapy compared to standard guidelines.
• The u-prevent.com tool aids in personalized risk assessment and medication effect modeling.

Conclusions:

• Treatment decisions for hypercholesterolemia in adults aged 75+ should prioritize patient-centered, lifetime benefits.
• Clinician-patient shared decision-making, informed by a specialized risk tool, is crucial for optimizing lipid-lowering therapy.
• This approach enhances risk-benefit discussions by considering individual life expectancy and frailty.