高强度他汀类药物治疗“过度”，因此不适用于高龄患者。

High-Intensity Statin Therapy Is "Too Much," Thus Not Indicated for Very Elderly Patients.

作者信息

Lee Ok Sang, Zhang Jinlong, Jung Sun-Hoi, Kim Hyang-Sook, Lee Myung-Koo, Lee Hae-Young

机构信息

Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea.

College of Pharmacy, Chungbuk National University, Cheongju, Republic of Korea.

出版信息

Pulse (Basel). 2018 Jul;6(1-2):19-31. doi: 10.1159/000485659. Epub 2018 Apr 12.

DOI:10.1159/000485659

PMID:30283750

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6140601/

Abstract

PURPOSE

Although moderate- to high-intensity statin therapy is increasingly recommended in cardiovascular disease patients, the efficacy and safety in elderly patients have not been proven clearly. Here, we compare the effect of various-intensity statins between elderly and very elderly patients.

METHODS

43,870 patients over 65 years old who were treated with statins were screened using electronic medical record data.

RESULTS

We evaluated 451 patients in the elderly group aged 65-74 years and 159 patients in the very elderly group over 75 years old. Baseline cholesterol profiles were similar between the 2 groups, but the 10-year atherosclerotic cardiovascular disease (ASCVD) risk was significantly higher in the very elderly (20.9 ± 11.5$ vs. 37.2 ± 13.6$, 0.001). The reduction rate of low-density lipoprotein (LDL) (-40.2 ± 21.3$ vs. -39.3 ± 21.0$, = 0.634) and the ratio of target LDL attainment (74.2 vs. 79.2$, = 0.252) were similar between the 2 groups. Low-intensity statins showed comparable LDL cholesterol reduction with moderate-intensity statins both in the elderly and the very elderly groups. The 10-year ASCVD risk reduction was similar between the 2 groups (-3.5 ± 4.9$ vs. -3.0 ± 8.4$, = 0.480), but in the very elderly group, no different ASCVD reduction rate was shown in low- to high-intensity statins ( = 0.784). Only the elderly group showed a significant correlation ( = 0.112, = 0.017) with LDL reduction and 10-year ASCVD risk. Interestingly, the incidence of adverse drug reaction (ADR) was higher in the very elderly group (4.4$) than in the elderly group (2.7$) and was more frequent in high-intensity statin therapy.

CONCLUSION

The efficacy of statins in LDL reduction was similar between the elderly and very elderly population. However, the benefit of moderate- to high-intensity statins is limited considering potential ADR. Therefore, the stepwise intensification of statin therapy might be necessary for the very elderly in spite of the higher cardiovascular risk.

摘要

目的

尽管越来越多的人建议心血管疾病患者接受中高强度他汀类药物治疗，但老年患者使用他汀类药物的疗效和安全性尚未得到明确证实。在此，我们比较老年和高龄患者使用不同强度他汀类药物的效果。

方法

利用电子病历数据筛选出43870例65岁以上接受他汀类药物治疗的患者。

结果

我们评估了65 - 74岁老年组的451例患者和75岁以上高龄组的159例患者。两组的基线胆固醇水平相似，但高龄组的10年动脉粥样硬化性心血管疾病（ASCVD）风险显著更高（20.9±11.5对37.2±13.6，P<0.001）。两组的低密度脂蛋白（LDL）降低率（-40.2±21.3对-39.3±21.0，P = 0.634）和达到目标LDL的比例（74.2对79.2，P = 0.252）相似。在老年组和高龄组中，低强度他汀类药物降低LDL胆固醇的效果与中强度他汀类药物相当。两组的10年ASCVD风险降低相似（-3.5±4.9对-3.0±8.4，P = 0.480），但在高龄组中，低强度至高强度他汀类药物的ASCVD降低率无差异（P = 0.784）。只有老年组的LDL降低与10年ASCVD风险之间存在显著相关性（P = 0.112，P = 0.017）。有趣的是，高龄组的药物不良反应（ADR）发生率（4.4%）高于老年组（2.7%），且在高强度他汀类药物治疗中更常见。