Hic sunt leones, or prevention of complications of atherosclerosis in asymptomatic elderly

Česká verzia

Authors: prof. MUDr. Jan Piťha, CSc.
Authors place of work: Centrum experimentální medicíny IKEM ; Interní klinika, 2. LF UK a FN Motol, Laboratoř pro výzkum aterosklerózy
Published in the journal: Geriatrie a Gerontologie 2020, 9, č. 2: 85-92
Category: Review Article

Summary

The main goal of hypolipidemic therapy in the elderly (persons older than 75-80 years) is longer life, preferably of better quality. Cardiovascular events of atherosclerotic origin are still the most common cause of morbidity and mortality in general population of developed countries, and this risk substantially increases with age. On the other hand, older people are also those most sensitive to the side effects of otherwise in this field very successful therapy with hydroxy-methyl-coenzyme A reductase inhibitors (statins). Despite the proven benefit of statins in the general population, only a few substudies have reliably evaluated effect of statins in patients older than 75-80 years, especially in the treatment of asymptomatic individuals (in primary prevention). Therefore, there is still unequivocal evidence in this field in terms of statin treatment and reliable data are lacking. However, given that we must make decisions about the treatment of these people or patients on daily basis, we have tried to present kind of pragmatic approach to this topic.

Keywords:

statins – elderly – cardiovascular diseases – primary prevention

Zdroje

1. Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002; 360:1623-1630.

2. Mortensen MB, Falk E. Primary Prevention With Statins in the Elderly. J Am Coll Cardiol 2018;71(1):85-94.

3. Authors/Task Force Members; ESC Committee for Practice Guidelines (CPG); ESC National Cardiac Societies. 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Atherosclerosis 2019; 290: 140–205.

4. Soška V, Vrablík M, Bláha V, et al. [PCSK9 inhibitors - new possibilities in the treatment of hypercholesterolemia: For which patients will be indicated? Czech atherosclerosis society statement]. Vnitr Lek 2016;62(4):329-33.

5. Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet 2013; 381: 752–762.

6. O‘Neill D, Stone NJ, Forman DE. Primary Prevention Statins in Older Adults: Personzalized Care for a Heterogeneous Population. J Am Geriatr Soc 2020. http://www.ncbi.nlm.nih.gov/pubmed/?term=31967323

7. de Zeeuw D, Anzalone DA, Cain VA, et al. Renal effects of atorvastatin and rosuvastatin in patients with diabetes who have progressive renal disease (PLANET I): a randomised clinical trial. Lancet Diabetes Endocrinol 2015;3:181–190.

8. Antwi SO, Li Z, Mody K, et al. Independent and Joint Use of Statins and Metformin by Elderly Patients With Diabetes and Overall Survival Following HCC Diagnosis. J Clin Gastroenterol 2020;54(5):468-476.

9. Buda V, Prelipcean A, Andor M, et al. Potentially Inappropriate Prescriptions in Ambulatory Elderly Patients Living in Rural Areas of Romania Using STOPP/START (Version 2) Criteria. Clin Interv Aging 2020;15:407-417.

10. Zhou Z, Albarqouni L, Curtis AJ, et al. The Safety and Tolerability of Statin Therapy in Primary Prevention in Older Adults: A Systematic Review and Meta-analysis. Drugs Aging 2020. http://www.ncbi.nlm.nih.gov/pubmed/?term=31919804

11. Alsehli AM, Olivo G, Clemensson LE, et al. The Cognitive Effects of Statins are Modified by Age. Sci Rep 2020;10(1):6187. doi: 10.1038/s41598-020-63035-2.

12. Mach F, Ray KK, Wiklund O, et al. European Atherosclerosis Society Consensus Panel. Adverse effects of statin therapy: perception vs. the evidence - focus on glucose homeostasis, cognitive, renal and hepatic function, haemorrhagic stroke and cataract. Eur Heart J 2018;39(27):2526-2539.

13. https://clinicaltrials.gov/ct2/show/NCT04262206

14. Stavrou EP, Buckley N, Olivier J, et al. Discontinuation of statin therapy in older people: does a cancer diagnosis make a difference? An observational cohort study using data linkage. BMJ Open 2012;2(3):e000880.

15. Kutner JS, Blatchford PJ, Taylor DH, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med 2015;175(5):691-700.

16. White N, Reid F, Harris A, et al. A systematic review of predictions of survival in palliative care: how accurate are clinicians and who are the experts? PLOS One 2016;11(8):e0161407.

17. Giral P, Neumann A, Weill A, et al. Cardiovascular effect of discontinuing statins for primary prevention at the age of 75 years: a nationwide population-based cohort study in France. Eur Heart J 2019;40(43): 3516-3525.

18. Lefeber GJ, Koek HL, Souverein PC, et al. Statins After Myocardial Infarction in the Oldest: A Cohort Study in the Clinical Practice Research Datalink Database. J Am Geriatr Soc 2020; 68(2):329-336.

19. Zullo AR, Ofori-Asenso R, Wood M, et al. Effects of Statins for Secondary Prevention on Functioning and Other Outcomes Among Nursing Home Residents. Journal of the American Medical Directors Association 2020; 21:500-507.

20. Qi K, Reeve E, Hilmer SN, et al. Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia. Int J Pharm 2015;37:949-957.

21. Shah RC, Supiano MA, Greenland P. Aligning the 4Ms of Age-Friendly Health Systems With Statin Use for Primary Prevention. J Am Geriatr Soc 2020 http://www.ncbi.nlm.nih.gov/pubmed/?term=31967318

22. Stolker JM, Spertus JA, Cohen DJ, et al. Rethinking composite end points in clinical trials: insights from patients and trialists. Circulation 2014;130(15):1254-61.

23. Bonnet F, Bénard A, Poulizac P, et al. Discontinuing statins or not in the elderly? Study protocol for a randomized controlled trial. Trials 2020;21(1):342.

24. Piťha J, Topinková E, Blaha V, et al. Léčba statiny u osob vyššího věku. Geri a Gero 2019; 8 (1): 3–9

25. Walsh S, King E, Brayne C. France removes state funding for dementia drugs. BMJ 2019;367:l6930.

26. Gupta A, Thompson D, Whitehouse A, et al. ASCOT Investigators.: Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Lancet 2017; 389 (10088):2473-2481.