White Alyssa M B, Mishcon Hillary R, Redwanski John L, Hills Ronald D
Department of Pharmaceutical Sciences and Administration, University of New England, Portland, ME 04103, USA.
Department of Pharmacy Practice, School of Pharmacy, University of New England, Portland, ME 04103, USA.
J Clin Med. 2020 Nov 21;9(11):3748. doi: 10.3390/jcm9113748.
Ample evidence supports the use of statin therapy for secondary prevention in patients with a history of atherosclerotic cardiovascular disease (ASCVD), but evidence is wanting in the case of primary prevention, low-risk individuals, and elderly adults 65+. Statins are effective in lowering low-density lipoprotein (LDL), which has long been a target for treatment decisions. We discuss the weakening dependence between cholesterol levels and mortality as a function of age and highlight recent findings on lipoprotein subfractions and other superior markers of ASCVD risk. The efficacy of statins is compared for distinct subsets of patients based on age, diabetes, ASCVD, and coronary artery calcium (CAC) status. Most cardiovascular risk calculators heavily weight age and overestimate one's absolute risk of ASCVD, particularly in very old adults. Improvements in risk assessment enable the identification of specific patient populations that benefit most from statin treatment. Derisking is particularly important for adults over 75, in whom treatment benefits are reduced and adverse musculoskeletal effects are amplified. The CAC score stratifies the benefit effect size obtainable with statins, and forms of coenzyme Q are discussed for improving patient outcomes. Robust risk estimator tools and personalized, evidence-based approaches are needed to optimally reduce cardiovascular events and mortality rates through administration of cholesterol-lowering medications.
大量证据支持他汀类药物疗法用于有动脉粥样硬化性心血管疾病（ASCVD）病史患者的二级预防，但在一级预防、低风险个体以及65岁以上老年人中，证据尚不充分。他汀类药物在降低低密度脂蛋白（LDL）方面有效，长期以来LDL一直是治疗决策的目标。我们讨论了胆固醇水平与死亡率之间随年龄变化而减弱的相关性，并强调了脂蛋白亚组分和其他ASCVD风险更优标志物的最新研究发现。根据年龄、糖尿病、ASCVD和冠状动脉钙化（CAC）状态，比较了他汀类药物对不同患者亚组的疗效。大多数心血管风险计算器严重加权年龄并高估个体患ASCVD的绝对风险，尤其是在非常年长的成年人中。风险评估的改进有助于识别最能从他汀类药物治疗中获益的特定患者群体。风险降低对75岁以上成年人尤为重要，因为他们的治疗益处降低而肌肉骨骼不良影响会放大。CAC评分将他汀类药物可获得的获益效应大小进行分层，并讨论了辅酶Q的形式以改善患者预后。需要强大的风险评估工具和个性化的循证方法，以通过使用降胆固醇药物来最佳地降低心血管事件和死亡率。
