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Drugs & Aging
Erschienen in: Drugs & Aging 11/2009

01.11.2009 | Review Article

Lipid-Lowering Therapy for the Primary Prevention of Cardiovascular Disease in the Elderly

Opportunities and Challenges

verfasst von: Dr Jennifer G. Robinson

Erschienen in: Drugs & Aging | Ausgabe 11/2009

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Abstract

Although HMG-CoA reductase inhibitors (statins) have been shown to reduce the risk of cardiovascular events in patients aged 65–80 years who have clinical cardiovascular disease, fewer data are available for elderly patients without cardiovascular disease. Treatment guidelines recommend a low-density lipoprotein cholesterol goal of <100 mg/dL for those with cardiovascular disease or diabetes mellitus but vary in their recommendations for primary prevention. Moderate-dose statins have been shown to be effective and safe in properly selected elderly patients up to the age of 80 years. High-dose statins have also been shown to be effective and reasonably safe in patients without significant co-morbidities up to the age of 75 years. With advancing age, the potential for benefit from cholesterol-lowering treatment needs to be weighed against the increasing risk of muscle and hepatic toxicity, as well as competing causes of morbidity and mortality.
Literatur
1.
Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics — 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009; 119: 480–6PubMedCrossRef
2.
Strong K, Mathers C, Leeder S, et al. Preventing chronic diseases: how many lives can we save? Lancet 2005; 366: 1578–82PubMedCrossRef
3.
Rothwell P, Coull A, Silver L, et al. Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet 2005; 366: 1773–83PubMedCrossRef
4.
National Heart, Lung, and Blood Institute. Morbidity and mortality: 2007 chart book on cardiovascular, lung, and blood diseases. Bethesda (MD): National Institutes of Health, 2007
5.
6.
Fries JF. Frailty, heart disease, and stroke: the compression of morbidity paradigm. Am J Prev Med 2005; 29(5 Suppl. 1): 164–8PubMedCrossRef
7.
Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics — 2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2006; 115: e69–171PubMedCrossRef
8.
Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383–9
9.
The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349–57CrossRef
10.
Holmes HM, Hayley DC, Alexander GC, et al. Reconsidering medication appropriateness for patients late in life. Arch Intern Med 2006; 166: 605–9PubMedCrossRef
11.
Robinson JG, Bakris G, Torner J, et al. Is it time for a cardiovascular primary prevention trial in the elderly? Stroke 2007; 38: 441–50PubMedCrossRef
12.
Denke M, Grundy S. Hypercholesterolemia in the elderly. Ann Intern Med 1990; 112: 780–92PubMed
13.
Pasternak RC, Smith Jr SC, Bairey-Merz CN, et al. ACC/AHA/NHLBI clinical advisory on the use and safety of statins. Circulation 2002; 106: 1024–8PubMedCrossRef
14.
Rasheed Q, Nair R, Sheehan H, et al. Correlation of intra-coronary ultrasound plaque characteristics in atherosclerotic coronary artery disease patients with clinical variables. Am J Cardiol 1994; 73: 753–8PubMedCrossRef
15.
Chaudhry SI, Krumholz HM, Foody JM. Systolic hypertension in older persons. JAMA 2004; 292: 1074–80PubMedCrossRef
16.
Mendelsohn ME, Karas RH. Molecular and cellular basis of cardiovascular gender differences. Science 2005; 308: 1583–7PubMedCrossRef
17.
Mackenbach JP, Kunst AE, Lautenbach H, et al. Gains in life expectancy after elimination of major causes of death: revised estimates taking into account the effect of competing causes. J Epidemiol Community Health 1999; 53: 32–7PubMedCrossRef
18.
Anum EA, Adera T. Hypercholesterolemia and coronary heart disease in the elderly: a meta-analysis. Ann Epidemiol 2004; 14: 705–21PubMedCrossRef
19.
Psaty BM, Anderson M, Kronmal RA, et al. The association between lipid levels and the risks of incident myocardial infarction, stroke, and total mortality: the Cardiovascular Health Study. J Am Geriatr Soc 2004; 52: 1639–47PubMedCrossRef
20.
Sturgeon JD, Folsom AR, Longstreth WT, et al. Risk factors for intracerebral hemorrhage in a pooled prospective study. Stroke 2007; 38: 2718–25PubMedCrossRef
21.
Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366: 1267–78CrossRef
22.
Shepherd J, Cobbe S, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333: 1301–7PubMedCrossRef
23.
Downs J, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/Tex CAPS. JAMA 1998; 279: 1615–22PubMedCrossRef
24.
Shepherd J, Blauw G, Murphy M, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002; 360: 1623–30PubMedCrossRef
25.
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin versus usual care: the Anti-hypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA 2002; 288: 2998–3007CrossRef
26.
Sever PS, Dahlof B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial — Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 2003; 361: 1149–58PubMedCrossRef
27.
Nakamura H, Arakawa K, Itakura H, et al. Primary prevention of cardiovascular disease with pravastatin in Japan (MEGA Study): a prospective randomised controlled trial. Lancet 2006; 368: 1155–63PubMedCrossRef
28.
Ridker PM, Danielson E, Fonseca FAH, et al. Rosu-vastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008; 359: 2195–207PubMedCrossRef
29.
National Cholesterol Education Panel. 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) final report. Circulation 2002; 106: 3143–21
30.
Heart 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: 7–22CrossRef
31.
Robinson JG, Smith B, Maheshwari N, et al. Pleiotropic effects of statins: benefit beyond cholesterol reduction? A meta-regression analysis. J Am Coll Cardiol 2005; 46: 1855–62PubMedCrossRef
32.
Manninen V, Elo MO, Frick MH, et al. Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study. JAMA 1988; 260: 641–51PubMedCrossRef
33.
The FIELD Study Investigators. Effects of long-term feno-fibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005; 366: 1849–61CrossRef
34.
Lipid Research Clinics. The Lipid Research Clinics Coronary Primary Prevention Trial results: I. Reduction in incidence of coronary heart disease. JAMA 1984; 251: 351–64CrossRef
35.
Hendrie HC. Epidemiology of dementia and Alzheimer’s disease. Am J Geriatr Psychiatry 1998; 6: S3–18PubMedCrossRef
36.
Seshadri S, Wolf P. Lifetime risk of stroke and dementia: current concepts, and estimates from the Framingham study. Lancet Neurol 2007; 6(12): 1106–14PubMedCrossRef
37.
Centers for Disease Control and Prevention. Trends in aging: United States and worldwide. MMWR Morb Mortal Wkly Rep 2003; 52: 101–6
38.
39.
Fitzpatrick AL, Kuller LH, Ives DG, et al. Incidence and prevalence of dementia in the Cardiovascular Health Study. J Am Geriatr Soc 2004; 52: 195–204PubMedCrossRef
40.
Hachinski V, Iadecola C, Petersen RC, et al. National Institute of Neurological Disorders and Stroke: Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke 2006; 37: 2220–41PubMedCrossRef
41.
Baune BT. The puzzle of predicting the impact of brain infarcts on cognitive impairment in the aging brain. Stroke 2009; 40: 667–9PubMedCrossRef
42.
Rosenberg IH. Rethinking brain food. Am J Clin Nutr 2007; 86: 1259–60PubMed
43.
Brayne C, Fox C, Boustani M. Dementia screening in primary care: is it time? JAMA 2007; 298: 2409–11PubMedCrossRef
44.
Eckert G, Muller W, Wood W. Cholesterol-lowering drugs and Alzheimer’s disease. Future Lipidol 2007; 2: 423–32CrossRef
45.
Ponce J, de La Ossa NP, Hurtado O, et al. Simvastatin reduces the association of NMDA receptors to lipid rafts: a cholesterol-mediated effect in neuroprotection. Stroke 2008; 39: 1269–75PubMedCrossRef
46.
Foody JM, Rathore SS, Galusha D, et al. Hydroxy-methylglutaryl-CoA reductase inhibitors in older persons with acute myocardial infarction: evidence for an age-statin interaction. J Am Geriatr Soc 2006; 54: 421–30PubMedCrossRef
47.
Aronow WS, Ahn C. Incidence of new coronary events in older persons with prior myocardial infarction and serum low-density lipoprotein cholesterol >=125mg/dL treated with statins versus no lipid-lowering drug. Am J Cardiol 2002; 89: 67–9PubMedCrossRef
48.
Aronow WS, Ahn C, Gutstein H. Incidence of new athero-thrombotic brain infarction in older persons with prior myocardial infarction and serum low-density lipoprotein cholesterol >=125mg/dL treated with statins versus no lipid-lowering drug. J Gerontol A Biol Sci Med Sci 2002; 57: M333–5PubMedCrossRef
49.
Packard CJ, Ford I, Robertson M, et al. Plasma lipoproteins and apolipoproteins as predictors of cardiovascular risk and treatment benefit in the PROspective Study of Pra-vastatin in the Elderly at Risk (PROSPER). Circulation 2005; 112: 3058–65PubMedCrossRef
50.
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: 1071–80PubMedCrossRef
51.
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: results of the Study Assessing Goals in the Elderly (SAGE). Circulation 2007; 115: 700–7PubMedCrossRef
52.
Grundy SM, Cleeman JI, Merz CNB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110: 227–39PubMedCrossRef
53.
54.
55.
56.
57.
58.
59.
60.
61.
Crouse III JR, Raichlen JS, Riley WA, et al. Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: the METEOR trial. JAMA 2007; 297: 1344–53PubMedCrossRef
62.
Nissen SE, Nicholls SJ, Sipahi I, et al. Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID Trial. JAMA 2006; 295: 1556–65PubMedCrossRef
63.
Davidson M, Robinson JG. Safety of aggressive lipid management. J Am Coll Cardiol 2007; 49: 1753–62PubMedCrossRef
64.
Robinson J. Management of complex lipid abnormalities with a fixed dose combination of simvastatin and extended release niacin. Vasc Health Risk Man 2009; 5: 31–43
65.
Jones PH, Davidson MH, Kashyap ML, et al. Efficacy and safety of ABT-335 (fenofibric acid) in combination with rosuvastatin in patients with mixed dyslipidemia: a phase 3 study. Atherosclerosis 2009; 204: 208–15PubMedCrossRef
66.
Shepherd J, Vidt D, Miller E, et al. Safety of rosuvastatin: update on 16 876 rosuvastatin-treated patients in a multinational clinical trial program. Cardiology 2007; 107: 433–43PubMedCrossRef
67.
Hey-Hadavi J, Kuntze E, LePetri B. Atorvastatin safety in patients 75 years and older [abstract]. J Clin Lipid 2007; 1: 164CrossRef
68.
Robinson JG, Davidson MH, Shah A, et al. Efficacy and safety of ezetimibe and ezetimibe plus statin therapy in patients aged under 65, 65-74 and 75 years and older. Aging Health 2007; 3: 691–705CrossRef
69.
Kashani A, Phillips CO, Foody JM, et al. Risks associated with statin therapy: a systematic overview of randomized clinical trials. Circulation 2006; 114: 2788–97PubMedCrossRef
70.
Pedersen TR, Faergeman O, Kastelein JJP, et al. High-dose atorvastatin versus usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA 2005; 294: 2437–45PubMedCrossRef
71.
Tikkanen MJ, Holme I, Cater NB, et a1. Comparison of efficacy and safety of atorvastatin (80 mg) to simvastatin (20 to 40 mg) in patients aged <65 versus >=65 years with coronary heart disease (from the Incremental DEcrease through Aggressive Lipid Lowering [IDEAL] study). Am J Cardiol 2009; 103: 577–82PubMedCrossRef
72.
De Lemos JA, Blazing MA, Wiviott SD, et al. Early intensive versus a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial. JAMA 2004; 292: 1307–16PubMedCrossRef
73.
MacMahon M, Kirkpatrick C, Cummings C, et al. A pilot study with simvastatin and folic acid/vitamin B12 in preparation for the Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH). Nutr Metab Cardiovasc Dis 2000; 10: 195–203PubMed
74.
Collins R, Armitage J, for the SEARCH Collaborative Group. Results of the Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH). New Orleans (LA): American Heart Association Scientific Sessions, 2008
75.
Cohen D, Anania F, Chalasani N. An assessment of statin safety by hepatologists. Am J Cardiol 2006; 97(8 Suppl. 1): S77–81CrossRef
76.
Thompson PD, Clarkson PM, Rosenson RS. An assessment of statin safety by muscle experts. Am J Cardiol 2006; 97(8 Suppl. 1): S69–76CrossRef
77.
Alsheikh-Ali AA, Trikalinos T, Kent DM, et al. Statins, low-density lipoprotein cholesterol, and risk of cancer. J Am Coll Cardiol 2008; 52: 1141–7PubMedCrossRef
78.
LaRosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005; 352: 1425–35PubMedCrossRef
79.
Bonovas S, Sitaras NM. Does pravastatin promote cancer in elderly patients? A meta-analysis. CMAJ 2007; 176: 649–54PubMedCrossRef
80.
Setoguchi S, Glynn RJ, Avorn J, et al. Statins and the risk of lung, breast, and colorectal cancer in the elderly. Circulation 2007; 115: 27–33PubMedCrossRef
81.
Strandberg T, Pyorala K, Cook TJ, et al. Mortality and incidence of cancer during 10-year follow-up of the Scandinavian Simvastatin Survival Study (4S). Lancet 2004; 364: 771–7PubMedCrossRef
82.
Bulbulia R, Bowman L, Wallendazus K, et al. MRC/BHF Heart Protection Study (HPS): mortality, cancer incidence and major vascular events during 4 years post-trial follow-up of HPS [abstract plus oral presentation]. J Am Coll Cardiol 2007; 49(9 Suppl. 1): A394A
83.
Goldstein LB, Amarenco P, Szarek M, et al. Hemorrhagic stroke in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study. Neurology 2007; 70: 2364–70PubMedCrossRef
84.
Heart Protection Study Collaborative Group. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20,536 people with cerebro-vascular disease or other high-risk complications. Lancet 2004; 363: 757–67CrossRef
85.
De Backer G, Ambrosioni E, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of eight societies and by invited experts). Eur Heart J 2003; 24: 1601–10PubMedCrossRef
86.
87.
Greving JP, Buskens E, Koffijberg H, et al. Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk. Circulation 2008; 117: 2875–83PubMedCrossRef
88.
Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA 2003; 290: 86–97PubMedCrossRef
Metadaten
Titel
Lipid-Lowering Therapy for the Primary Prevention of Cardiovascular Disease in the Elderly
Opportunities and Challenges
verfasst von
Dr Jennifer G. Robinson
Publikationsdatum
01.11.2009
Verlag
Springer International Publishing
Erschienen in
Drugs & Aging / Ausgabe 11/2009
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI
https://doi.org/10.2165/11318270-000000000-00000

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