Almost two thirds of major coronary events take place in subjects over 65 years of age. Old (65–75 years), very old (75–85 years), and oldest old (85+ years) individuals should be considered separately when addressing cardiovascular (CV) risk. Several observational investigations have shown that the relationship between plasma cholesterol and CV events is less stringent with advancing age, especially in the very old and oldest old subject. In this context, both a decrease in total cholesterol and low HDL-C levels may be linked to coronary morbidity and total mortality through an independent association with disability and frailty. On the other hand, although elevated plasma LDL-C might still represent a CV risk factor in older people, the potential benefits originating from its reduction may exceed those obtained in younger ages, given the higher prevalence of CV disease in late life. At present statins, which represent the most effective hypocholesterolemic drugs, have been shown to significantly reduce CV events up to 82 years of age in randomized controlled trials and epidemiological surveys. The occurrence of multiple chronic conditions (comorbidity), decreased life expectancy and polypharmacotherapy suggest the need for a careful assessment of indications for aggressive hypolipidemic treatment. Drug interactions and low-pharmacological adherence may concur, causing a failure of preventive measure or side effects. Specific guidelines do not always recommend special caution or prudence in the elderly, but the selection of older patients for hypolipidemic treatment requires a high grade of clinical judgment.
Dyslipidemias in the older subject: features, significance and treatment dilemmas
VIGNA, Giovanni Battista;FELLIN, Renato;ZULIANI, Giovanni
2011
Abstract
Almost two thirds of major coronary events take place in subjects over 65 years of age. Old (65–75 years), very old (75–85 years), and oldest old (85+ years) individuals should be considered separately when addressing cardiovascular (CV) risk. Several observational investigations have shown that the relationship between plasma cholesterol and CV events is less stringent with advancing age, especially in the very old and oldest old subject. In this context, both a decrease in total cholesterol and low HDL-C levels may be linked to coronary morbidity and total mortality through an independent association with disability and frailty. On the other hand, although elevated plasma LDL-C might still represent a CV risk factor in older people, the potential benefits originating from its reduction may exceed those obtained in younger ages, given the higher prevalence of CV disease in late life. At present statins, which represent the most effective hypocholesterolemic drugs, have been shown to significantly reduce CV events up to 82 years of age in randomized controlled trials and epidemiological surveys. The occurrence of multiple chronic conditions (comorbidity), decreased life expectancy and polypharmacotherapy suggest the need for a careful assessment of indications for aggressive hypolipidemic treatment. Drug interactions and low-pharmacological adherence may concur, causing a failure of preventive measure or side effects. Specific guidelines do not always recommend special caution or prudence in the elderly, but the selection of older patients for hypolipidemic treatment requires a high grade of clinical judgment.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
