Rhee Taeho Greg, Kumar Manish, Ross Joseph S, Coll Patrick P
Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.
J Am Geriatr Soc. 2021 May;69(5):1272-1282. doi: 10.1111/jgs.17038. Epub 2021 Feb 17.
OBJECTIVES: To examine age-related trajectories of cardiovascular risk and use of aspirin and statin among U.S. adults aged 50 or older. DESIGN: Repeated cross-sectional study using data from 2011 to 2018 National Health and Nutrition Examination Surveys. SETTING: Nationally representative health interview survey in the United States. PARTICIPANTS: Non-institutionalized adults aged 50 years and older (n = 11,392 unweighted). MEASUREMENTS: Primary prevention was defined as the prevention of a first cardiovascular event including coronary heart disease, angina/angina pectoris, heart attack, or stroke, whereas secondary prevention was defined as those with a history of these clinical conditions. Medication use was determined by self-report; aspirin use included dose and frequency, and statin use included generic names, days of prescription fills, and indications. We examined linear trends between age and each medication use, after controlling for period, sex, and race/ethnicity. RESULTS: Prevalence of those eligible for primary prevention treatment increased with age from 31.8% in ages 50-54 to 52.0% in ages ≥75 (p < 0.001). Similarly, those eligible for secondary prevention treatment increased with age from 2.7% in ages 50-54 to 21.1% in ages ≥75 (p < 0.001). Low-dose daily aspirin use increased with age (p < 0.001), and 45.3% of adults aged ≥75 took low-dose aspirin daily for primary prevention. Statin use also increased with age (p < 0.001), and 56.4% of adults aged ≥75 had long-term statin use for secondary prevention. CONCLUSION: While adults aged ≥75 do not benefit from the use of aspirin to prevent the first CVD, many continue to take aspirin on a regular basis. In spite of the clear benefit of statin use to prevent a subsequent CVD event, many older adults in this risk category are not taking a statin. Further education and guidance for both healthcare providers and older adults regarding the appropriate use of aspirin and statins to prevent CVD is needed.
目的:研究美国50岁及以上成年人心血管疾病风险以及阿司匹林和他汀类药物使用情况与年龄的关系轨迹。 设计:采用2011年至2018年国家健康与营养检查调查数据进行重复横断面研究。 地点:美国具有全国代表性的健康访谈调查。 参与者:50岁及以上的非机构化成年人(未加权n = 11392)。 测量:一级预防定义为预防首次心血管事件,包括冠心病、心绞痛、心脏病发作或中风,而二级预防定义为有这些临床疾病史的患者。药物使用情况通过自我报告确定;阿司匹林使用情况包括剂量和频率,他汀类药物使用情况包括通用名称、处方取药天数和用药指征。在控制了时期、性别和种族/族裔因素后,我们研究了年龄与每种药物使用之间的线性趋势。 结果:符合一级预防治疗条件者的患病率随年龄增长而增加,从50 - 54岁的31.8%增至75岁及以上的52.0%(p < 0.001)。同样,符合二级预防治疗条件者的患病率也随年龄增长而增加,从50 - 54岁的2.7%增至75岁及以上的21.1%(p < 0.001)。低剂量每日服用阿司匹林的情况随年龄增长而增加(p < 0.001),75岁及以上成年人中有45.3%每日服用低剂量阿司匹林进行一级预防。他汀类药物的使用也随年龄增长而增加(p < 0.001),75岁及以上成年人中有56.4%长期使用他汀类药物进行二级预防。 结论:虽然75岁及以上成年人无法从使用阿司匹林预防首次心血管疾病中获益,但许多人仍继续定期服用阿司匹林。尽管使用他汀类药物预防后续心血管疾病事件有明确益处,但该风险类别中的许多老年人未服用他汀类药物。需要针对医疗服务提供者和老年人就适当使用阿司匹林和他汀类药物预防心血管疾病提供进一步的教育和指导。
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