高胆固醇血症老年患者的评估和治疗:临床综述
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
概括
在80岁以上的个体中,高胆固醇血症的治疗是复杂的. 虽然他类药物可能对一些人有益,但由于缺乏针对这个年龄组的特定试验证据,决定必须是个性化的.
科学领域:
- 老年学是一门学科.
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 高胆固醇血症在80岁以上的人群中很普遍.
- 在这一群体中存在显著的功能变化,影响治疗决策.
- 与年轻患者相比,老年人使用静止剂需要仔细考虑.
研究的目的:
- 审查80岁及以上个体高胆固醇血症的呈现,影响因素和治疗.
- 具体解决他类药物在这个人口群体中的作用.
主要方法:
- 在MEDLINE和其他来源的文献搜索 (1990-2014).
- 包括个人图书馆和手动搜索指南和评论 (2000-2014) 的参考列表.
主要成果:
- 没有随机临床试验 (RCT) 具体包括在基线80岁以上的个体.
- 75-80岁患者的证据和观察性研究表明,他类药物对动脉样硬化心血管疾病 (ASCVD) 的二次预防有益,可能在没有ASCVD的糖尿病患者中也是如此.
- 老年人没有增加与他类药物相关的危害,这使得初级预防成为一种可能性.
- 由于预期寿命,脆弱性,并发症和多药性等方面的异质性,个性化治疗决策至关重要.
结论:
- 对于ASCVD风险的最佳高胆固醇血症管理理想情况下在80岁之前开始.
- 缺乏RCT证据来指导80岁后开始服用他类药物.
- 老年人使用静止剂的决定是个性化的,缺乏高质量的支持性证据.
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