Dornbrook-Lavender Kimberly A, Pieper John A, Roth Mary T
Division of Pharmacotherapy, School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Ann Pharmacother. 2003 Nov;37(11):1654-63. doi: 10.1345/aph.1D025.
To review relevant literature supporting the use of antihypertensive agents, lipid-lowering agents (i.e., statins), and aspirin therapy for the primary prevention of coronary heart disease (CHD) in an elderly patient population (age >or=65 y).
A MEDLINE search (1988-January 2003) was conducted.
Primary and tertiary literature involving the uses of antihypertensives, statins, and aspirin therapy in the elderly were reviewed.
Mortality due to CHD in the US population has decreased 40-50% over the last 30 years; however, CHD remains the leading cause of morbidity and mortality in elderly persons. As the population continues to age, the number of older adults eligible for primary prevention will rise. The American Heart Association clinical practice guidelines for the primary prevention of CHD were updated in 2002; however, they are based on findings from clinical trials that enrolled predominantly middle-aged white men. The recommendations for elderly individuals are predominantly extrapolated from subgroup analyses of randomized clinical trials or cohort studies. This literature suggests that elderly persons are candidates for primary prevention measures and experience reductions in coronary events when treated with appropriate therapies.
Data suggest that use of antihypertensives, statins, and aspirin therapy in the elderly appears effective to an extent similar to, and often greater than, that observed in younger patients. We believe these agents should be prescribed to all appropriate high-risk elderly patients. Ongoing and future studies will more clearly elucidate the benefits of primary prevention therapy, particularly in persons >or=75 years of age.
回顾支持使用抗高血压药物、降脂药物（即他汀类药物）和阿司匹林治疗以对老年人群（年龄≥65岁）进行冠心病（CHD）一级预防的相关文献。
进行了MEDLINE检索（1988年1月至2003年1月）。
对涉及老年人使用抗高血压药物、他汀类药物和阿司匹林治疗的一级和三级文献进行了综述。
在过去30年中，美国人群中因冠心病导致的死亡率下降了40%至50%；然而，冠心病仍然是老年人发病和死亡的主要原因。随着人口持续老龄化，符合一级预防条件的老年人数量将会增加。美国心脏协会关于冠心病一级预防的临床实践指南于2002年进行了更新；然而，这些指南是基于主要纳入中年白人男性的临床试验结果制定的。针对老年人的建议主要是从随机临床试验或队列研究的亚组分析中推断出来的。这些文献表明，老年人是一级预防措施的适用对象，并且在接受适当治疗时冠心病事件会减少。
数据表明，在老年人中使用抗高血压药物、他汀类药物和阿司匹林治疗在一定程度上似乎与在年轻患者中观察到的效果相似，且往往更好。我们认为这些药物应该开给所有合适的高危老年患者。正在进行的和未来的研究将更清楚地阐明一级预防治疗的益处，特别是在年龄≥75岁的人群中。
