Department of Cardiology AOU Maggiore della Carita, Universita del Piemonte Orientale, Novara, Italy.
Department of Cardiology, AOU San Giovanni di Dio Ruggi d'Aragona, Universita di Salerno, Salerno, Italy.
Curr Vasc Pharmacol. 2019;17(3):233-238. doi: 10.2174/1570161116666180628145723.
Elderly patients represent a rising social problem, due to the exponential growth of persons in these age groups and their atherothrombotic burden. The management of this population still raises several challenges, requiring a balance between elevated cardiovascular risk, clinical complexity, frailty and co-morbidities. Statins represent the main pillar in cardiovascular prevention, lowering serum cholesterol and reducing mortality and ischemic events, especially in high-risk patients. Yet, elderly patients have often been excluded from major clinical trials of statins, thus limiting the experience with these drugs in advanced age. Moreover, important barriers to the use of statins in the elderly exist due to potential risks attributed to altered metabolism, comorbidities, polypharmacy and drug-drug interactions and financial constraints. This situation has led to a "statin paradox", since high-risk elderly patients, that would most benefit from the use of statins, may be undertreated with these drugs in real life. The vague indications provided by guidelines mean that this issue is still debated, especially regarding primary prevention. Nevertheless, the benefits in outcome offered by statins cannot be neglected. Efforts should be made in order to focus on the importance of statin use in the elderly and to provide clinicians with adequate tools for case by case decisions.
老年患者是一个日益严重的社会问题，这主要是由于该年龄段人群的数量呈指数级增长，且他们存在动脉粥样硬化血栓形成的负担。这类人群的管理仍然存在许多挑战，需要在升高的心血管风险、临床复杂性、脆弱性和合并症之间取得平衡。他汀类药物是心血管预防的主要支柱，可降低血清胆固醇并降低死亡率和缺血事件的发生风险，尤其是高危患者。然而，老年患者通常被排除在他汀类药物的主要临床试验之外，因此限制了在高龄人群中使用这些药物的经验。此外，由于代谢改变、合并症、多种药物治疗和药物相互作用以及经济限制等潜在风险，老年患者使用他汀类药物存在重要障碍。这种情况导致了“他汀悖论”，因为最需要使用他汀类药物的高风险老年患者在现实生活中可能得不到充分治疗。指南提供的模糊指征意味着这个问题仍存在争议，特别是在一级预防方面。然而，他汀类药物带来的获益不容忽视。应该努力关注老年患者使用他汀类药物的重要性，并为临床医生提供针对具体病例的决策的适当工具。
