Treatment of dyslipidemia in the elderly patients

Abstract

The manifestations of atherosclerotic disease (coronary artery disease, cerebrovascular and/or peripheral disease) may have even more deleterious repercussions in elderly. In the elderly, although the number of coronary events decreases with age (relative risk), the number of patients who would benefit from “prevention” (treatment) annually, per 1000 individuals, tends to be higher than in young individuals (absolute risk). Advanced age alone should not be considered as a limiting factor for therapeutic intervention in cases of dyslipidemia. The analysis of life expectancy and quality of life are extremely important. Disabling diseases that compromise life expectancy, such as: severe heart failure, advanced cerebrovascular disease, dementia, neoplasms and frailty, when present, limit the possibility of any type of preventive cardiovascular treatment. Another limiting factor is the frequent previous use of a large number of medications, due to the possibility of increasing unfavorable drug interactions. Combined strategies of physical activity, diet, tobacco and alcohol use, adherence to medication, screening, vaccination and cognitive and mental health have been proposed as specific preventive recommendations for each decade. The most common dyslipidemia in this age group is secondary caused by pathologies such as diabetes mellitus, obesity, renal failure and also by the use of drugs that alter the lipid profile. When prescribing lipid-lowering drugs for individuals over the age of 65 years it is necessary to remember that there are numerous changes in the “aged” organism and, therefore, treatment should be started with lower doses than those usually prescribed for young adults; the increase should be gradual and analyzed in each case individually. Statins and fibrates are the lipid-lowering drugs that have shown better tolerability in the elderly and are therefore the first choice medications. PCSK9 inhibitor is most probably indicated in Familial Hypercholesterolemia patients.