Cholesterol metabolism disturbances and statin therapy in elderly patients
Authors:
P. Vyroubal
Authors‘ workplace:
Interní JIP, III. interní gerontometabolická klinika LF UK a FN Hradec Králové
Published in:
Geriatrie a Gerontologie 2013, 2, č. 2: 74-78
Category:
Review Article
Overview
Elderly people are the fastest growing population segment in high-income countries. One of the most common causes of death among the elderly are cardiovascular diseases (CVD). Age itself is one of the strongest predictors of CVD risk and hypercholesterolaemia is the most important risk factor of CVD. However, these assumptions seem to be based on extrapolations from studies carried out in younger adults. Clinical efficacy and safety of statin therapy have been well established by a series of large-scale, randomised controlled trials. The results of the trial evaluating exclusively elderly patients have contributed enormously to our understanding of the use of statins in the elderly. However a review of the few randomised controlled trials including 80+ year olds did not provide evidence of beneficial effects of lipid-lowering treatment on total mortality in the 80+ year-old group. This review article deals with the benefits and risks of therapy of cholesterol metabolism disturbances in elderly patients.
Keywords:
cholesterol – old age – elderly patients – lipid-lowering treatment – cardiovascular and overall mortality
Sources
1. Long SB, Blaha JM, Blumenthal RS et al.: Clinical utility of rosuvastatin and other statins for cardiovascular risk reduction among the elderly. Clin Interv Aging 2011; 6: 27–35.
2. Hradec J, Bultas J, Kmínek A et al.: Jak se léčí statiny v České
republice? Výsledky průzkumu STEP. Cor Vasa 2011; 53: 527–534.
3. Špinar J.: Hladiny cholesterolu v závislosti na věku. Vnitř Lék 2009; 55(9): 724–29.
4. Vyroubal P, Chiarla C, Giovannini I a kol.: Hypocholesterolemia in clinically serious conditions – review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008; 152(2): 181–89.
5. Dawber TR, Moore FE, Mann GV: Am J Public Health Nations Health. 1957; 47(4 Pt 2): 4–24.
6. The multiple risk factor intervention trial (MRFIT). A national study of primary prevention of coronary heart disease. JAMA 1976; 235(8): 825–27.
7. Verschuren WM, Jacobs DR, Bloemberg BP et al.: Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study.
8. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the scandinavian simvastatin survival study (4S). Lancet 1994; 344 (8934): 1383–89.
9. Shepherd J, Cobbe SM, Ford I et al.: for the West of Scotland Coronary Prevention Study Group (WOSCOPS). Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333: 1301–07.
10. Brensike JF, Levy RI, Kelsey SF et al.: Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of the NHLBI Type II Coronary Intervention Study. Circulation 1984; 69: 313–24.
11. Jukema JW, Bruschke VG, van Boven AJ et al.: Effects of lipid lowering by pravastatin on progression and regression of coronary artery disease in symptomatic men with normal to moderately elevated serum cholesterol levels. The regression growth evaluation statin study (REGRESS). Circulation 1995; 91: 2528–40.
12. Nissen SE, Tuzcu EM, Schoenhagen P et al.: Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA 2004; 291(9): 1071–80.
13. Hearth protection study collaborative group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002; 360(9326): 7–22.
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): 1623–30.
15. Brugts JJ, Yetgin T, Hoeks SE et al.: The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: Meta-analysis of randomized controlled trials. BMJ 2009; 338: b2376.
16. Cholesterol treatment trialists (CTT) collaboration. Lack of effect of lowering LDL cholesterol on cancer: meta-analysis of individual data from 175,000 people in 27 randomised trials of statin therapy. PloS One 2012; 7(1): e29849.
17. Deedwania P, Stone PH, Bairey Merz CN et al.: Effects of intensive versus moderate lipid-lowering therapy on myocardial ischemia in older patients with coronary heart disease. Circulation 2007; 115: 700–70.
18. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult treatment panel III). JAMA 2001; 285(19): 2486–97.
19. Lewington S, Whitlock G, Clarke R et al.: Blood cholesterol and vascular mortality by age, sex and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 2007; 370: 1829–39.
20. Anum EA, Adera T: Hypercholesterolemia and coronary heart disease in the elderly: a meta-analysis. Ann Epidemiol 2004; 14: 705–21.
21. Petersen LK, Christensen K, Kragstrup J: Lipid-lowering treatment to the end? A review of observational studies and RCTs on cholesterol and mortality in 80+ year olds. Age and Ageing 2010; 39: 674–80.
22. Weverling-Rijnsburger AW, Jonkers IJ, van Exel E et al.: High-density vs low-density lipoprotein cholesterol as the risk factor for coronary artery disease and stroke in old age. Arch Intern Med 2003; 163(13): 1549–54.
23. Górecká K, Tilšer I, Nachtigal P et al.: Extralipidové účinky statinů – nový pohled na farmakodynamiku inhibitorů HMG-CoA reduktázy. Remedia 2004; 14(4): 355–63.
24. Švejda P: Statiny a osteoporóza. Vnitř Lék 2006; 52(12): 1190–93.
25. Kjekshus J, Apetrei E. Barrios V et al.: Rosuvastatin in older patients with systolic heart failure. N Engl J Med 2007; 357(22): 2248–61.
26. Belosta S, Paoletti R, Corsini A: Safety of statins: focus on clinical pharmacokinetics and drug interactions. Circulation 2004; 109 (23 Suppl 1): III50–57.
27. Alla V, Abraham J, Siddiqui J et al.: Autoimmune hepatitis triggered by statins. J Clin Gastroenterol 2006; 40(8): 757–61.
28. Dujovne CA: Side effects of statins: hepatitis versus „transaminitis“ – myositis versus CPKitis. Am J Cardiol 2002; 89(12): 1411–13.
29. Armitage J: The safety of statins in clinical practice. Lancet 2007; 370 (9601):1781–90.
30. Sattar N, Preiss D, Murray HM et al: Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010; 375 (9716): 735–42.
Labels
Geriatrics Gynaecology and obstetrics Internal medicine Neurology General practitioner for adults Orthopaedic prostheticsArticle was published in
Geriatrics and Gerontology
2013 Issue 2
Most read in this issue
- Haemodialysis treatment of elderly patients with renal failure - current state of affairs and future prospects
- Cholesterol metabolism disturbances and statin therapy in elderly patients
- Intensive geriatric care - effective solutions for the future rise of elderly population
- Aortic valve stenosis in elderly patients