Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
Clin Interv Aging. 2011;6:27-35. doi: 10.2147/CIA.S8101. Epub 2010 Dec 22.
Age is one of the strongest predictors of cardiovascular disease (CVD) risk. Treatment with statins can significantly reduce CVD events and mortality in both primary and secondary prevention. Yet despite the high CVD risk among the elderly, there is underutilization of statins in this population (ie, the treatment-risk paradox). Few studies have investigated the use of statins in the elderly, particularly for primary prevention and, as a result, guidelines for treating the elderly are limited. This is likely due to: uncertainties of risk assessment in older individuals where the predictive value of individual risk factors is decreased; the need to balance the benefits of primary prevention with the risks of polypharmacy, health care costs, and adverse medication effects in a population with decreased life expectancy; the complexity of treating patients with many other comorbidities; and increasingly difficult social and economic concerns. As life expectancy increases and the total elderly population grows, these issues become increasingly important. JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) is the largest primary prevention statin trial to date and enrolled a substantial number of elderly adults. Among the 5695 JUPITER participants ≥ 70 years of age, the absolute CVD risk reduction associated with rosuvastatin was actually greater than for younger participants. The implications of this JUPITER subanalysis and the broader role of statins among older adults is the subject of this review.
年龄是心血管疾病（CVD）风险的最强预测因素之一。他汀类药物治疗可以显著降低一级和二级预防中的 CVD 事件和死亡率。然而，尽管老年人的 CVD 风险很高，但在该人群中他汀类药物的使用率仍然较低（即治疗风险悖论）。很少有研究调查了他汀类药物在老年人中的使用情况，特别是在一级预防方面，因此，治疗老年人的指南有限。这可能是由于：在个体危险因素预测价值降低的老年人中，风险评估存在不确定性；需要平衡一级预防的益处与多药治疗、医疗保健成本和预期寿命降低的人群中药物不良反应的风险；治疗伴有许多其他合并症的患者的复杂性；以及日益困难的社会和经济问题。随着预期寿命的延长和老年人口的增加，这些问题变得越来越重要。JUPITER（使用他汀类药物预防的正当性：评估瑞舒伐他汀的干预试验）是迄今为止最大的一级预防他汀类药物试验，纳入了大量老年患者。在 5695 名 JUPITER 参与者中≥70 岁的患者中，与瑞舒伐他汀相关的绝对 CVD 风险降低实际上大于年轻参与者。本 JUPITER 亚分析的意义以及他汀类药物在老年人中的更广泛作用是本综述的主题。
