老年人降低胆固醇:我们应该等待进一步的证据吗?
Yasser A Jamil1, Rachel Cohen2, Dana K Alameddine1
1Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Current atherosclerosis reports
|July 3, 2024
概括
对于75岁以上的成年人,降脂疗法 (LLT) 的指导方针尚不清楚. 共享决策是初级预防的关键,在开始服用他类药物之前考虑个体因素.
科学领域:
- 心脏病学 心脏病学
- 老年病的医生 老年病的医生
- 预防医学 预防医学
背景情况:
- 目前的心血管事件预防指南是为75岁以下的成年人制定的.
- 关于降脂疗法 (LLT) 的建议,特别是用于初级预防,对于75岁及以上的成年人来说是不确定的.
研究的目的:
- 审查低密度脂蛋白胆固醇 (LDL-C) 作为动脉样硬化心血管疾病 (ASCVD) 风险预测因子,在75岁以上的成年人中.
- 评估这个人口群体目前的风险评估工具和LLT指导方针.
- 讨论老年人LLT的益处,风险和描述策略.
主要方法:
- 审查现有的文学和关于LLT的指导方针,以预防75岁以上的成年人心血管疾病.
- 分析LDL-C在老年人ASCVD风险预测中的作用.
- 评估风险评估工具,包括新兴的基于生物年龄的方法,如冠状动脉分数.
主要成果:
- 老年人中LDL-C与死亡率/心血管结果之间的关联是复杂而混的.
- 目前的ASCVD风险计算器缺乏老年特异变量;新兴工具专注于生物年龄.
- 老年人没有确立特定的LDL-C目标和非他类药物值,因此需要依赖年轻人群的数据.
- 共享决策至关重要,权衡时间获益,预期寿命和潜在的不良事件.
- 建议在终身护理中停止处方LLT,但其在适合或脆弱的老年人中的应用需要进一步明确.
- 一般来说,LLT是ASCVD后适当的事件,而抑郁症被认为接近生命终结.
结论:
- 对于75岁以上的成年人,没有有限的预期寿命和无ASCVD,在共同决策后,可以考虑结合生活方式和药物治疗方法 (包括他类药物).
- 需要进一步的研究和正在进行的试验,以指导老年人服用他类药物的处方和降低处方策略.
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