Döser S, März W, Reinecke M-F, Ringleb P, Schultz A, Schwandt P, Becker H J, Bönner G, Buerke M, Diener H C, Gohlke H, Keil U, Ringelstein E B, Steinmetz A, Gladisch R, Wehling M
IV. Medizinische Klinik, Fakultät für Klinische Medizin Mannheim, Ruprecht-Karls-Universität Heidelberg.
Internist (Berl). 2004 Sep;45(9):1053-62. doi: 10.1007/s00108-004-1268-6. Epub 2004 Aug 3.
Elderly patients are significantly less likely to receive statins than younger patients possibly because of doubts regarding compliance or concerns regarding the increased likelihood of adverse events and drug interactions. Poor compliance can be expected especially in patients suffering from dementia or depression as well as those whose stage of cardiovascular disease exhibits few symptoms. On the other hand, the clinical significance of CHD events is high in the elderly, and 80% of coronary deaths occur in patients aged over 65 years. The average statistical life expectancy of elderly and old patients is often underestimated. The HPS and PROSPER studies showed that statins reduce mortality and morbidity even in very elderly individuals with a high global cardiovascular risk and/or CAD. Patients up to the age of 79 years should be treated according to the same guidelines as younger patients. Statin therapy should only be considered for patients aged 80 years and older who are at a very high risk for cardiovascular events.
老年患者接受他汀类药物治疗的可能性明显低于年轻患者,这可能是因为对依从性存在疑虑,或者担心不良事件和药物相互作用的可能性增加。尤其是患有痴呆症或抑郁症的患者以及心血管疾病症状较少的患者,预计其依从性较差。另一方面,冠心病事件在老年人中的临床意义重大,80%的冠状动脉死亡发生在65岁以上的患者中。老年和高龄患者的平均预期统计寿命常常被低估。心脏保护研究(HPS)和普伐他汀对高危老年人血管事件及再发中风的预防研究(PROSPER)表明,即使是全球心血管风险高和/或患有冠心病的非常年长的个体,他汀类药物也能降低死亡率和发病率。79岁及以下的患者应按照与年轻患者相同的指南进行治疗。他汀类药物治疗仅应考虑用于心血管事件风险非常高的80岁及以上患者。