Metabolic Diseases Clinic, Geriatric Operating Unit, Department of Internal Medicine, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy -
Minerva Med. 2021 Dec;112(6):804-816. doi: 10.23736/S0026-4806.21.07347-X. Epub 2021 May 5.
The atherosclerotic cardiovascular disease (ASCVD) represents the leading cause of death and disability in the elderly. The study of atherosclerosis and the strategies to control ASCVD are evolving. All strategies emphasize the need to lower LDL cholesterol (LDL-C) through an appropriate lifestyle and the use of lipid-lowering drugs, mainly statins. Available evidence coming from clinical trials is useful to inform clinical choices, but the older people are poorly represented in those trials. Thus, evidence supporting the benefit of statin therapy for primary and secondary prevention of fatal and nonfatal ASCVD events in adults aged 75 years and older are limited. The pharmacological therapy of dyslipidemia is recommended by guidelines provided by international expert panels in adults, while in the elderly it is still a matter of debate. Statins are generally well tolerated drugs but their use in the elderly, especially in fragile ones or with multi-pathology that take many other drugs, requires a careful evaluation of the risk-benefit ratio and a shared decision- making process between doctor and patient.
动脉粥样硬化性心血管疾病（ASCVD）是老年人死亡和残疾的主要原因。对动脉粥样硬化的研究和控制 ASCVD 的策略正在不断发展。所有策略都强调需要通过适当的生活方式和使用降脂药物（主要是他汀类药物）来降低 LDL 胆固醇（LDL-C）。来自临床试验的现有证据有助于为临床决策提供信息，但这些试验中老年人的代表性较差。因此，支持他汀类药物治疗 75 岁及以上成年人一级和二级预防致命和非致命 ASCVD 事件的证据有限。国际专家小组制定的指南推荐对血脂异常进行药物治疗，但在老年人中，这仍然存在争议。他汀类药物通常是耐受性良好的药物，但在老年人中使用，特别是在脆弱或有多种疾病需要服用多种其他药物的老年人中，需要仔细评估风险-效益比，并在医生和患者之间进行共同决策。
