Statins are suitable for people over 70 years of age with a correct life expectancy – El Médico Interactivo

The risk of atherosclerotic cardiovascular disease increases with age and remains the leading cause of mortality in the elderly. The causal role of apolipoprotein B (apoB)-containing lipoproteins (LDL, very low-density lipoproteins) is well known. [VLDL] and its remnants) in the development and progression of cardiovascular disease, and that should be specified in the measurement of LDL-C. The lipid-lowering effect of statins is achieved by reversibly inhibiting the hepatic enzyme 3-hydroxy-methyl-glutaryl CoA (HMG-CoA) reductase. Statins have other pharmacodynamic effects such as antiaggregant action, modification of the activity of the vascular endothelium, stabilization of the atherosclerotic plaque, attenuation of the proliferation and migration of smooth muscle cells in the vascular intima, modulation of immunity, anti-inflammatory action and antioxidant. Recent studies have shown the importance of lowering cholesterol also in the elderly, to reduce the risk of cardiovascular events. Scientific evidence A systematic review and a meta-analysis that have evaluated the efficacy and safety of lipid-lowering treatments in patients over 75 years of age have shown that there was a significant decrease of 26% in cardiovascular disease and mortality, reducing LDL-C by 1mmol/L , without increasing the adverse effects, compared to the younger population. The adverse effects described with the use of statins are an increased incidence of diabetes, kidney failure, cataracts, cognitive impairment and impaired liver function and myopathies that, without being serious, can be disabling or affect the daily life of the patient. patient. Risk by age The majority of apparently healthy people over 70 years of age without cardiovascular risk factors, due to age alone, already have a moderate or high-very high cardiovascular risk. The indication to maintain LDL cholesterol levels below the established level should not be limited because the patient is older than 70 years. Combination When treatment with statins is insufficient, the combination with ezetimibe is effective in reducing coronary events, as confirmed in the IMPROVE-IT study and in the 7-year follow-up published in JAMA. Therefore, as long as the patient to be treated has a correct life expectancy, intensive treatment is a practice to be carried out, especially if one takes into account that it is a population with a high cardiovascular risk. Factors to take into account It is recommended to assess lipid-lowering treatment taking into account not only biological age, but also functional status, cognitive status, comorbidities, polypharmacy, quality of life, the patient’s wishes and social assessment. If it is decided to start lipid-lowering treatment, it should be done at low/moderate doses and progressively increased until reaching therapeutic goals or up to maximum tolerated doses, closely monitoring the patient’s progress. For the preparation of this article, we have had the collaboration of doctors specialists in Cardiology Grisel Castañeda Rodríguez, from the Igualada Hospital; Albina Aldoma Balasch and José Manuel Casanova Seuma, from the Arnau de Vilanova Hospital, in Lleida; the endocrinologists María Dolores Santos Rey and Ferran Rius Riu, from the Arnau de Vilanova Hospital, in Lleida, the nephrologist Jorge Roig Carcel, from the same hospital, and the internist Meritxell Royuela Juncadella, from the Sant Joan de Deu Hospital, in Manresa.