高コレステロール血症の高齢患者の評価と治療:臨床レビュー

Timo E Strandberg¹, Laura Kolehmainen², Alpo Vuorio³

¹Geriatric Clinic, Department of Medicine, University of Helsinki, Helsinki, Finland2Institute of Health Sciences/Geriatrics, University and University Hospital of Oulu, Oulu, Finland3Helsinki University Central Hospital, Helsinki, Finland.

JAMA

|September 17, 2014

まとめ

80歳以上の人の高コレステロール血症の治療は複雑です. スタチンは一部の患者にとって有益であるかもしれないが,この年齢層に対する特定の試験の証拠が不足しているため,決定は個別化されなければならない.

科学分野:

ゲロントロジーはゲロントロジーの学科です.
心臓病学心臓病学
薬理学薬理学とは

背景:

高コレステロール血症は80歳以上の個人に多く見られる.
この集団には重要な機能的変異性があり,治療決定に影響を与えます.
高齢者のスタチンの使用は,若い患者と比較して慎重に検討する必要があります.

研究の目的:

80歳以上の人における高コレステロール血症の呈現,影響因子,および治療の見直しを行う.
この集団におけるスタチンの役割について具体的に述べる.

主な方法:

MEDLINEおよびその他の情報源に関する文献検索 (1990年−2014年).
ガイドラインとレビュー (2000-2014) の個人図書館と参考リストの手動検索が含まれています.

主要な成果:

ランダム化臨床試験 (RCT) は,基値で80歳以上の個人を特に含めた試験はありませんでした.
75~80歳の患者からの証拠と観察研究では,スタチンは動脈硬化性心血管疾患 (ASCVD) の二次予防に有益であり,おそらくASCVDのない糖尿病患者でも有益であることを示唆しています.
スタチンに関連した害は,高齢者では増加していないので,一次予防は可能である.
個別化された治療決定は,平均寿命,脆弱性,併発性疾患,およびポリファーマシーにおける異質性のために決定的に重要です.

結論:

ASCVDリスクに対する最適の高コレステロレミア管理は,理想的には80歳以前に始まります.
80歳以降のスタチンの開始をガイドするRCTの証拠は不足しています.
高齢者におけるスタチンの使用の決定は個別化され,高品質の裏付け証拠が不足しています.

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