Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Institute of Primary Health Care (Berner Institut für Hausarztmedizin, BIHAM), University of Bern, Bern, Switzerland.
J Am Geriatr Soc. 2020 Feb;68(2):417-425. doi: 10.1111/jgs.16219. Epub 2019 Oct 30.
As a person's age increases and his/her health status declines, new challenges arise that may lead physicians to consider deprescribing statins. We aimed to provide insight into recommendations available in international cardiovascular disease prevention guidelines regarding discontinuation of statin treatment applicable to older adults.
We systematically searched PubMed, EMBASE, EMCARE, and the websites of guideline development organizations and online guideline repositories for cardiovascular disease prevention guidelines aimed at the general population. We selected all guidelines with recommendations (instructions and suggestions) on discontinuation of statin treatment applicable to older adults, published between January 2009 and April 2019. In addition, we performed a synthesis of information from all other recommendations for older adults regarding statin treatment. Methodological quality of the included guidelines was appraised using the appraisal of guidelines for research & evaluation II (AGREE II) instrument.
Eighteen international guidelines for cardiovascular disease prevention in the general adult population provided recommendations for statin discontinuation that were applicable to older adults. We identified three groups of instructions for statin discontinuation related to statin intolerance, and none was specifically aimed at older adults. Three guidelines also included suggestions to consider statin discontinuation in patients with poor health status. Of the 18 guidelines included, 16 made recommendations regarding statin treatment in older adults, although details on how to implement these recommendations in practice were not provided.
Current international cardiovascular disease prevention guidelines provide little specific guidance for physicians who are considering statin discontinuation in older adults in the context of declining health status and short life expectancy. J Am Geriatr Soc 68:417-425, 2020.
随着年龄的增长和健康状况的下降，人们会面临新的挑战，这可能导致医生考虑停止使用他汀类药物。我们旨在深入了解国际心血管疾病预防指南中关于停止他汀类药物治疗的建议，这些建议适用于老年人。
我们系统地检索了 PubMed、EMBASE、EMCARE 以及指南制定组织的网站和在线指南存储库，以获取针对普通人群的心血管疾病预防指南。我们选择了所有针对老年人的他汀类药物治疗停药建议（指示和建议）的指南，这些指南发表于 2009 年 1 月至 2019 年 4 月之间。此外，我们还综合了所有其他针对老年人他汀类药物治疗的建议信息。使用评估研究和评价指南 II（AGREE II）工具评估纳入指南的方法学质量。
18 项针对普通成年人群的心血管疾病预防国际指南提供了适用于老年人的他汀类药物停药建议。我们确定了三组与他汀类药物不耐受相关的他汀类药物停药指示，但没有一组专门针对老年人。有三个指南还包括了在健康状况不佳的患者中考虑停止他汀类药物治疗的建议。在纳入的 18 项指南中，有 16 项针对老年人的他汀类药物治疗提出了建议，尽管没有提供如何在实践中实施这些建议的详细信息。
目前的国际心血管疾病预防指南在医生考虑在健康状况下降和预期寿命较短的情况下停止使用他汀类药物治疗老年人时，几乎没有提供具体的指导。美国老年医学会 68:417-425, 2020.
