在高危老年患者中使用他类药物降脂疗法:治疗风险悖论
Dennis T Ko1, Muhammad Mamdani, David A Alter
1Division of Cardiology, Schulich Heart Centre, and Department of Medicine, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario.
JAMA
|April 22, 2004
概括
医生对高风险患者处方他类药物较少,尽管有证据表明他类药物对二次心血管预防有好处. 最佳的他类药物使用需要优先考虑高风险人群,以最大限度地提高心血管健康结果.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
背景情况:
- 包括他类药物在内的心血管疗法对于二次预防至关重要.
- 这些疗法的最佳利用应与患者的心血管风险保持一致.
- 目前的做法可能无法在高风险人群中充分利用他类药物.
研究的目的:
- 为了研究医生治疗强度和患者基线心血管风险之间的关系.
- 为了确定他类药物处方模式是否与预测的心血管风险相关.
主要方法:
- 在安大略省使用链接的医疗保健行政数据库进行了回顾性队列研究.
- 包括396,077名66岁以上的患有心血管疾病或糖尿病的患者.
- 使用3年死亡预测指数建模的基线风险.
主要成果:
- 在二次预防队列中,只有19.1%的患者接受了他类药物治疗.
- 随着基线心血管风险和预测死亡率的增加,他类药物处方率下降.
- 年龄和基线风险相互影响,老年患者和更高风险显示较低的他类药物使用.
结论:
- 达丁类药物处方与心血管风险和预测死亡率相反相关.
- 由于在高风险患者中使用量不足,他类药物的最大益处可能无法实现.
- 实施他类药物治疗需要优先考虑心血管风险最大的个体.
相关概念视频
Lipid-Lowering Drugs: Statins and Miscellaneous Agents
1.8K
Hyperlipidemia, a medical condition often referred to as high cholesterol, is characterized by abnormally elevated levels of lipids in the bloodstream. When present in excess, these lipids, specifically cholesterol and triglycerides, can lead to serious health complications, often involving cardiovascular diseases. Illnesses like atherosclerosis, heart attacks, and pancreatitis have all been linked to untreated hyperlipidemia. This means controlling and regulating cholesterol and triglyceride...
1.8K
Drug Dosing: Geriatric Patients
400
Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
400
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution
387
Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are...
387
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism
405
Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
405
Coronary Artery Disease V: Interprofessional Care
450
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
450
Atherosclerosis III: Management
747
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
747


