Shepherd James
Department of Pathological Biochemistry, University Department of Pathological Biochemistry, Royal Infirmary, Glasgow, G4 0SF, Scotland, UK.
Atheroscler Suppl. 2003 Dec;4(5):17-22. doi: 10.1016/s1567-5688(03)90003-1.
Statins reduce coronary and cerebrovascular morbidity and mortality in middle-aged individuals but their efficacy and safety in elderly people has not been confirmed. Several clinical trials including the Cholesterol and Recurrent Events (CARE) and Long-term Intervention with Pravastatin in Ischemic Disease (LIPID), have sub-analysed their results for the 'elderly' cohort, but the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) trial is the first trial to specifically evaluate the benefits of statin therapy on vascular risk in elderly men and women. The results have shown that pravastatin, given for 3 years, reduced the risk of coronary heart disease in elderly individuals. Within this same time frame, there was no significant benefit on the risk reduction of stroke but there was a trend to reduce the risk of transient ischemic attacks. It was discovered that those patients with the lowest baseline high-density lipoprotein cholesterol gained the most benefit from the intervention. Drug interactions between pravastatin and the concomitant medications seen in this elderly cohort, was not a significant clinical issue. Therefore, PROSPER extends to elderly individuals the treatment strategy currently used in middle-aged people.
他汀类药物可降低中年个体的心血管和脑血管发病率及死亡率，但其在老年人中的疗效和安全性尚未得到证实。包括胆固醇与再发事件研究（CARE）和普伐他汀长期干预缺血性疾病研究（LIPID）在内的多项临床试验，对其“老年”队列的结果进行了亚组分析，但老年高危人群普伐他汀前瞻性研究（PROSPER）试验是首个专门评估他汀类药物治疗对老年男性和女性血管风险益处的试验。结果显示，服用3年普伐他汀可降低老年个体患冠心病的风险。在同一时间范围内，对降低中风风险没有显著益处，但有降低短暂性脑缺血发作风险的趋势。研究发现，基线高密度脂蛋白胆固醇水平最低的患者从干预中获益最大。在该老年队列中观察到的普伐他汀与同时服用药物之间的药物相互作用，并非重大临床问题。因此，PROSPER将目前用于中年人的治疗策略扩展到了老年人。
