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Dyslipidemia and Cardiovascular Prevention in the Elderly: A Balance between Benefits and Risks of Statin Treatment
Vincenzo Fiore1, Alessandra Barucca1, Sonia Barraco1
1UOSD Diabetologia, Endocrinologia, ASL RM5, Rome, Italy.
Insights
Statins effectively reduce cardiovascular disease (CVD) risk in elderly patients. Careful assessment of individual risk factors and potential interactions is crucial before prescribing statin therapy for optimal outcomes.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Atherosclerotic cardiovascular diseases (CVD) are a leading cause of death globally, particularly in older adults.
- Statins are primary pharmacological agents for managing atherosclerosis and reducing coronary artery disease risk.
- Increased life expectancy leads to a higher burden of comorbidities in the elderly population.
Purpose of the Study:
- To examine the role of statins in managing atherosclerosis and associated burdens in elderly patients.
- To evaluate the efficacy and safety of statin therapy in older individuals.
Main Methods:
- Review of current guidelines and evidence on statin use in elderly populations.
- Analysis of cardiovascular risk assessment algorithms, including age-specific considerations.
- Evaluation of factors influencing statin therapy decisions in the elderly.
Main Results:
- Statins significantly lower CVD risk in both primary and secondary prevention, especially in high-risk elderly individuals.
- Current guidelines recommend age-irrespective risk assessment algorithms, acknowledging the benefits of statins in those over 70.
- Life expectancy expansion favors statin treatment benefits in the elderly.
Conclusions:
- Statin therapy is recommended for elderly patients to prevent cardiovascular events, despite potential adverse events.
- Prescribing statins requires a comprehensive assessment beyond baseline cardiovascular risk, considering frailty, polypharmacy, cognitive status, and comorbidities.
- Appropriate selection of statin type and dosage is essential to minimize adverse events, with lower doses and hydrophilic statins potentially being safer.
Introduction:
Atherosclerotic Cardiovascular Diseases (CVD) are among the most relevant causes of morbidity and mortality worldwide, especially in aged people. Statins are one of the leading pharmacological interventions against atherosclerosis and are widely used to reduce the risk of occurring coronary artery diseases and related outcomes in both primary and secondary prevention. The management of chronic diseases is improved considerably over time, leading to an increase in life expectancy despite heavier comorbidity-related burdens in the elderly.
Aims:
The paper focused on the role of statins in the management of atherosclerosis and related burdens in elderly patients.
Results:
Statins are essential in reducing the risk of CVD in secondary and primary prevention, particularly in high-risk individuals. Guidelines encourage using specific algorithms with age-specific cutoffs to assess individual cardiovascular risk irrespective of baseline age, as the expansion of life expectancy produces favorable effects of statin treatment in those over 70.
Discussion:
Besides the estimation of baseline CV risk, a specific age-related assessment is also necessary before prescribing statin treatment in aged people focusing on frailty, potential pharmacological interactions due to polypharmacotherapy, cognitive impairment, and background chronic comorbidities, such as diabetes mellitus. Before starting statin therapy, an accurate choice of type and dose of statins is needed as potential adverse events are more prevalent with high-dose than low-to-moderatedose regimens and with lipophile than hydrophile statins (e.g., potential implication on intra-cerebral cholesterol metabolism).
Conclusion:
Despite possible adverse events, elderly patients should receive statins, when appropriate, to avoid the first occurrence of recurrent cardiovascular events and related burdens.
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