在老年人中治疗高胆固醇血症,以预防心血管事件的初级预防
Awsse Al-Ani1,2, Yasser Jamil3, Ariela R Orkaby4,5,6
1New England GRECC (Geriatric Research, Education, and Clinical Center), VA Boston Healthcare System, Boston, MA, USA.
Drugs & aging
|August 10, 2024
概括
在75岁以上的成年人中,使用降脂药物预防动脉样硬化心血管疾病 (ASCVD) 的初级预防是不确定的. 需要更多的研究,包括专门的试验,以澄清这种不断增长的人口中的益处和风险.
科学领域:
- 老年医学 老年医学
- 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:
- 75岁及以上的美国人口正在迅速扩大,预计到2050年将达到450万.
- 动脉样性心血管疾病 (ASCVD) 是老年人死亡的主要原因,通常与高胆固醇血症有关.
- 目前在这个人群中使用降脂剂对ASCVD初级预防的证据是有限的,这是由于试验排除和依赖二次分析.
研究的目的:
- 审查当前关于老年人高胆固醇血症管理的指南.
- 评估现有的ASCVD风险预测模型对老年人群的局限性.
- 总结关于降脂疗法的证据,包括新药,以及它们对老年人的副作用.
- 确定即将到来的临床试验,重点关注老年人ASCVD初级预防.
主要方法:
- 对老年人高胆固醇血症的最新治疗指南的文献综述.
- 分析当前ASCVD风险评分对老年患者的适用性.
- 关于降脂剂 (他类药物,白酸) 和它们的不良事件的关键研究数据的综合.
- 确定正在进行和计划的临床试验,调查老年人群的降脂疗法.
主要成果:
- 现有的指导方针为75岁以上成年人进行ASCVD初级预防提供了有限的具体建议.
- 当前的ASCVD风险计算器可能会高估或低估老年人的风险.
- 对于降脂剂在75岁以上的ASCVD初级预防中的有效性和安全性的证据稀少,这一年龄组的参与者很少被纳入主要试验.
- 像白酸这样的新药显示出潜力,但需要在老年人群中进一步研究.
结论:
- 对于75岁及以上的成年人进行初级ASCVD预防,有必要制定基于证据的战略.
- 专门的临床试验至关重要,以确定降脂疗法的净益在这个脆弱和不断增长的人口.
- 未来的研究应该集中在老年特异性结果和降脂干预措施的安全概况上.
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