Statin therapy in elderly patients


Authors: Jan Piťha 1;  Eva Topinková 2;  Vladimír Bláha 3;  Božena Jurašková 4;  Ivo Bureš 5;  Iva Holmerová 6;  Vladimír Soška 8;  Michal Vrablík 7
Authors‘ workplace: Interní klinika 2. LF UK a FN Motol, Praha 1;  Geriatrická klinika 1. LF UK a VFN v Praze 2;  III. interní gerontometabolická klinika LF UK a FN Hradec Králové 3;  Subkatedra geriatrie LF UK Hradec Králové 4;  Geriatrické centrum Nemocnice Pardubice 5;  Geriatrické centrum Praha 6;  III. interní klinika 1. LF UK a VFN v Praze 7;  Oddělení klinické biochemie a II. interní klinika LF MU a FN u sv. Anny v Brně 8
Published in: Geriatrie a Gerontologie 2019, 8, č. 1: 3-9
Category:

Overview

Cardiovascular events occur most frequently in patients at higher age groups. The elderly suffer not only more advanced and complex changes of cardiovascular system but, also, other chronic conditions. Moreover, compared to middle-age, different therapeutic response is often observed due to changes of pharmaco-kinetics and -dynamics; these patients use other medications, which may trigger drug interactions. The situation is further complicated by non-adherence related to frequent cognitive impairment. On one hand the elderly enjoy the greatest absolute benefit from adequate cardiovascular treatment while on the other they might be more susceptible to adverse reactions. In spite of the fact statins represent preventative medications, they must be indicated cautiously taken into consideration comorbidities, frailty and disability occurring in advanced age. Frail and disabled patients have greater risk of statin adverse effects, however, even these patients have lower mortality rates while being on statins. In seniors with life expectancy exceeding 5 years statins, when indicated, bring unambiguously proven benefit and should be considered high-priority medications.

Keywords:

atherosclerosis – cardiovascular disease – dyslipidemia – elderly – frailty – management – statins


Sources

1. Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet 2013; 381(9868): 752–762. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(12)62167–9>. Erratum in Lancet 2013; 382(9901): 1328.

2. Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14(6): 392–397. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jamda.2013.03.022>.

3. Greco A, Paroni G, Seripa D, et al. Frailty, disability and physical exercise in the aging process and in chronic kidney disease. Kidney Blood Press Res 2014; 39(2–3):164–168. Dostupné z DOI: <http://dx.doi.org/10.1159/000355792>.

4. Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004; 59(3): 255–263.

5. Pavasini R, Guralnik J, Brown JC, et al. Short Physical Performance Battery and all-cause mortality: systematic review and meta-analysis. BMC Med 2016; 14(1):215. Dostupné z DOI: <http://dx.doi.org/10.1186/s12916–016–0763–7>.

6. Berková M, Topinková E, Mádlová P, et al. Krátká baterie pro testování fyzické zdatnosti seniorů – pilotní studie a validizace testu u starších osob v České republice. Vnitř Lék 2013; 59(4): 256–263.

7. Kalvach Z, Čeledová L, Holmerová I, et al. Křehký pacient a primární péče. Grada: Praha 2012.

8. Weber P, Prudius D, Meluzínová H. Geriatrická multimorbidita – jeden z klíčových problémů současné medicíny. Vnitř Lék 2015; 61(12): 1042–1048.

9. Yourman LC1, Lee SJ, Schonberg MA, et al. Prognostic indices for older adults: a systematic review. JAMA 2012; 307(12): 182–192. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.2011.1966>.

10. Strandberg TE, Kolehmainen L Vuorio A. Evaluation and treatment of older patients with hypercholesterolemia: a clinical review. JAMA 2014; 312(11): 1136–1144. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.2014.10924>

11. Mortensen MB, Falk E. Primary Prevention With Statins in the Elderly. J Am Coll Cardiol 2018; 71(1): 85–94. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2017.10.080>.

12. Stone NJ, Turin A, Spitz JA, et al. Statin therapy across the lifespan: evidence in major age groups. Expert Rev Cardiovasc Ther 2016; 14(3): 341–366. Dostupné z DOI: <http://dx.doi.org/10.1586/14779072.2016.1128825>.

13. (Heart Protection Study Collaborative Group). MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomized placebo-controlled trial. Lancet 2002; 360(9326): 7–22. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(02)09327–3>.

14. 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(9346): 1623–1630.

15. LaRosa JC, He J, Vupputuri S. Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA 1999; 282(24): 2340–2346.

16. Teng M, Lin L, Zhao YJ, et al. Statins for Primary Prevention of Cardiovascular Disease in Elderly Patients: Systematic Review and Meta-Analysis. Drugs Aging 2015; 32(8): 649–661. Dostupné z DOI: <http://dx.doi.org/10.1007/s40266–015–0290–9>.

17. Bláha V. Přínos statinů v geriatrii. Klin Farmakol Farm 2005; 19(3): 152–154.

18. Pilotto A, Gallina P, Panza F, et al. Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease. Am J Cardiol 2016; 118(11): 1624–1630. Dostupné z DOI: <http://dx.doi.org/10.1016/j.amjcard.2016.08.042>.

19. Pilotto A, Panza F, Copetti M, et al. Statin Treatment and Mortality in Community-Dwelling Frail Older Patients with Diabetes Mellitus: A Retrospective Observational Study. PLoS One 2015; 10(6): e0130946. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0130946>.

20. Ford I, Murray H, McCowan C, et al. Long-Term Safety and Efficacy of Lowering Low-Density Lipoprotein Cholesterol With Statin Therapy: 20-Year Follow-Up of West of Scotland Coronary Prevention Study. Circulation 2016; 133(11): 1073–1080. Dostupné z DOI: <http://dx.doi.org/10.1161/CIRCULATIONAHA.115.019014>.

21. Leya M, Stone NJ. Statin Prescribing in the Elderly: Special Considerations. Curr Atheroscler Rep 2017; 19(11): 47. Dostupné z DOI: <http://dx.doi.org/10.1007/s11883–017–0683–9>.

22. Noyes AM, Thompson PD. The effects of statins on exercise and physical activity. J Clin Lipidol 2017; 11(5): 1134–1144. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacl.2017.07.003>.

23. Scott D, Blizzard L, Fell J, et al. Statin therapy, muscle function and falls risk in community-dwelling older adults. QJM 2009; 102(9): 625–633. Dostupné z DOI: <http://dx.doi.org/10.1093/qjmed/hcp093>.

24. Reklou A, Doumas M, Imprialos K, et al. Reduction of Vascular Inflammation, LDL-C, or Both for the Protection from Cardiovascular Events? Open Cardiovasc Med J 2018; 12: 29–40. Dostupné z DOI: <http://dx.doi.org/10.2174/1874192401812010029>.

25. Strandberg TE, Urtamo A, Kähärä J, et al. Statin Treatment Is Associated With a Neutral Effect on Health-Related Quality of Life Among Community-Dwelling Octogenarian Men. J Gerontol A Biol Sci Med Sci 2018; 73(10): 1418–1423. Dostupné z DOI: <http://dx.doi.org/10.1093/gerona/gly073>.

26. Pella D, Gvozdjáková A, Lietava A, et al. Myopatie asociovaná se statiny: klinické doporučení Slovenskej asociácie aterosklerózy a České společnosti pro aterosklerózu. AtheroRev 2016; 1(1): 7–13.

27. Holmes HM, Todd A. Evidence-based deprescribing of statins in patients with advanced illness. JAMA Intern Med 2015; 175(5): 701–702. Dostupné z DOI: <http://dx.doi.org/10.1001/jamainternmed.2015.0328>.

28. Fialová D, Topinková E, Ballóková A, et al. Expertní konsensus ČR 2012 v oblasti léčiv a lékových postupů potenciálně nevhodných ve stáří. Oddíl I. Vhodnost volby léčiv a dávkovacích schémat u geriatrických pacientů Oddíl II Interakce lék-nemoc ve stáří. Klin Farmakol Farm 2013; 27(1): 18–28.

29. Deprescribing Guidelines and Algorithms. The evidence-based guidelines and their algorithms, developed by the Bruyère Research Institute Deprescribing Guidelines Research Team and its collaborators, are products of quality research and real-world application. Dostupné z WWW: <https://deprescribing.org/resources/deprescribing-guidelines-algorithms/>.

30. Cohen JD, Brinton EA, Ito MK, et al. Understanding Statin Use in America and Gaps in Patient Education (USAGE): An internet-based survey of 10,138 current and former statin users. J Clin Lipidol 2012; 6(3): 208–215. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacl.2012.03.003>.

31. A guide to deprescribing statins. Primary Health Tasmania. Dostupné z WWW: <https://www.primaryhealthtas.com.au/wp-content/uploads/2018/09/A-Guide-to-Deprescribing-Statins.pdf>

32. Richardson K, Schoen M, French B, et al. Statins and cognitive function: a systematic review. Ann Intern Med 2013; 159(10): 688–697. Dostupné z DOI: <http://dx.doi.org/10.7326/0003–4819–159–10–201311190–00007>.

33. Swiger KJ, Manalac RJ, Blumenthal RS, et al. Statins and cognition: a systematic review and meta-analysis of short- and long-term cognitive effects. Mayo Clin Proc 2013; 88(11): 1213–1221. Dostupné z DOI: <http://dx.doi.org/10.1016/j.mayocp.2013.07.013>.

34. Vrablík M, Piťha J, Bláha V, et al. Stanovisko výboru České společnosti pro aterosklerózu k doporučením ESC/EAS pro diagnostiku a léčbu dyslipidemií z roku 2016. AtheroRev 2017; 2(3): 185–193.

35. Antoniou GA, Hajibandeh S, Hajibandeh S, et al. Meta-analysis of the effects of statins on perioperative outcomes in vascular and endovascular surgery. J Vasc Surg 2015; 61: 519–532.e1. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jvs.2014.10.021>.

36. Sanders RD, Nicholson A, Lewis SR, et al. Perioperative statin therapy for improving outcomes during and after noncardiac vascular surgery. Cochrane Database Syst Rev 2013; (7): CD009971. Dostupné z DOI: <http://dx.doi.org/10.1002/14651858.CD009971.pub2>.

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