Lipid Management in the Elderly Population
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Considering that deaths from cardiovascular disease have been increasing in proportion to population ageing, prevention and treatment of dyslipidemia in elderly people is essential to avoid such outcome. Some biomarkers, albeit with limitations, have shown effectiveness in predicting cardiovascular events. Among them, blood levels of C-reactive protein, Lipoprotein A and, especially, coronary artery calcium. Dyslipidemia management primarily includes changes in lifestyle, such as physical activity, diet and smoking cessation. However, in elderly, drug therapy may be necessary, with statins being the first line treatment. In addition, therapies with drugs that decrease intestinal cholesterol absorption or increase LDL absorption by the liver, for example, have shown benefit when added to conventional therapy. Therefore, this review aims to contemplate some aspects of dyslipidemia in the elderly population, since appropriate management of such condition can significantly avoid undesirable outcomes.
-
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2019 Update: A Report from the American Heart Association. Vol. 139, Circulation. 2019. 56–528 p.
Google Scholar
-
Pa CK. The effective history of critical theory: The reception history of Frankfurt school in Taiwan Universitas (Stuttg). 2010;37(6):111–25.
Google Scholar
-
Ference BA, Ginsberg HN, Graham I, Ray KK, Packard CJ, Bruckert E, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459–72.
DOI
Google Scholar
-
Berry JD, Dyer A, Cai X, Garside DB, Ning H, Thomas A, et al. Lifetime Risks of Cardiovascular Disease. N Engl J Med. 2012;366(4):321–9.
DOI
Google Scholar
-
Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al. Public Health and Prevention and the American College of Sports Medicine. J Am Med Assoc. 1995;273(5):402–7.
DOI
Google Scholar
-
Shao H, Chen LQ, Xu J. Treatment of dyslipidemia in the elderly. J Geriatr Cardiol. 2011;8(1):55–64.
DOI
Google Scholar
-
Adult Treatment Panel III (2002) Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults. Circulation 106: 31433421.
DOI
Google Scholar
-
Streja E, Streja DA. Management of Dyslipidemia in the Elderly [Internet]. Endotext [Internet]. 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279133/.
Google Scholar
-
Milionis HJ, Filippatos TD, Loukas T, Bairaktari ET, Tselepis AD, Elisaf MS. Serum lipoprotein(a) levels and apolipoprotein(a) isoform size and risk for first-ever acute ischaemic nonembolic stroke in elderly individuals. Atherosclerosis. 2006;187(1):170–6.
DOI
Google Scholar
-
Budoff MJ, Young R, Burke G, Carr JJ, Detrano RC, Folsom AR, et al. Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J. 2018;39(25):2401b-2408b.
DOI
Google Scholar
-
Lewis H. Kuller, Lopez OL, Macke RH, Rosano C, Edmundowicz D, Becker JT, et al. Subclinical Cardiovascular Disease and Death, Dementia, and Coronary Heart Disease in Individuals Age 80+. Physiol Behav. 2018;176(1):139–48.
Google Scholar
-
Shepherd J, Blauw GJ, Murphy MB, Bollen ELEM, Buckley BM, Cobbe SM, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): A randomised controlled trial. Lancet. 2002;360(9346):1623–30.
DOI
Google Scholar
-
Cholesterol Treatment Trialists’ (CTT) Collaborators (2005) Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90056 participants in 14 randomised trials of statins. Lancet 366: 12671278.
DOI
Google Scholar
-
Downs, J.R., Clearfield, M., Weis, S., Whitney, S., Shapiro, D.R., Beere, P.A. et al. (1998) Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: result of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 279: 16151622.
DOI
Google Scholar
-
Heart Protection Study Collaborative Group (2002) MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo controlled trial. Lancet 360: 722. Heart Protection S.
DOI
Google Scholar
-
Sever, P.S., Dahlof, B., Poulter, N.R., Wedel, H., Beevers, G., Caulfield, M. et al. (2003) Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the AngloScandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomized controlled trial. Lancet 361: 11491158.
DOI
Google Scholar
-
Neil, H.A., DeMicco, D.A., Luo, D., Betterridge, D.J., Colhoun, H.M., Durrington, P.N. et al. (2006) Analysis of efficacy and safety in patients aged 65-75 years at randomization: Collaborative Atorvastatin Diabetes Study (CARDS). Diabetes Care 29: 23782384.
DOI
Google Scholar
-
Hawley, C., Roefaro, J., Forman, D., & Orkaby, A. (2019). Statins for Primary Prevention in Those Aged 70 Years and Older: A Critical Review of Recent Cholesterol Guidelines. Drugs & Aging, 36(8), 687-699. doi: 10.1007/s40266-019-00673-w.
DOI
Google Scholar
-
Aronow WS. Pharmacologic therapy of lipid disorders in the elderly. Am J Geriatr Cardiol. 2002;11(4):247–56.
DOI
Google Scholar
-
Cannon CP, Blazing MA, Giugliano RP, McCagg A, White JA, Theroux P, et al. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med. 2015;372(25):2387–97.
DOI
Google Scholar
-
Bohula EA, Morrow DA, Giugliano RP, Blazing MA, He P, Park JG, et al. Atherothrombotic Risk Stratification and Ezetimibe for Secondary Prevention. J Am Coll Cardiol. 2017;69(8):911–21.
DOI
Google Scholar
-
Bach RG, Cannon CP, Giugliano RP, White JA, Lokhnygina Y, Bohula EA, et al. Effect of Simvastatin-Ezetimibe Compared with Simvastatin Monotherapy after Acute Coronary Syndrome among Patients 75 Years or Older: A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol. 2019;4(9):846–54.
DOI
Google Scholar
-
Sabatine MS, Giugliano RP, Keech AC, Honarpour N, Wiviott SD, Murphy SA, et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med. 2017;376(18):1713–22.
DOI
Google Scholar
-
Hlatky MA, Kazi DS. PCSK9 Inhibitors: Economics and Policy. J Am Coll Cardiol [Internet]. 2017;70(21):2677–87. Available from: https://doi.org/10.1016/j.jacc.2017.10.001.
DOI
Google Scholar