Ok Sang Lee, Jinlong Zhang, Sun-Hoi Jung, Hyang-Sook Kim, Myung-Koo Lee, Hae-Young Lee
{"title":"高强度他汀类药物治疗“过量”，因此不适用于高龄患者。","authors":"Ok Sang Lee, Jinlong Zhang, Sun-Hoi Jung, Hyang-Sook Kim, Myung-Koo Lee, Hae-Young Lee","doi":"10.1159/000485659","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Although moderate- to high-intensity statin therapy is increasingly recommended in cardiovascular disease patients, the efficacy and safety in elderly patients have not been proven clearly. Here, we compare the effect of various-intensity statins between elderly and very elderly patients.</p><p><strong>Methods: </strong>43,870 patients over 65 years old who were treated with statins were screened using electronic medical record data.</p><p><strong>Results: </strong>We evaluated 451 patients in the elderly group aged 65-74 years and 159 patients in the very elderly group over 75 years old. Baseline cholesterol profiles were similar between the 2 groups, but the 10-year atherosclerotic cardiovascular disease (ASCVD) risk was significantly higher in the very elderly (20.9 ± 11.5$ vs. 37.2 ± 13.6$, <i>p <</i> 0.001). The reduction rate of low-density lipoprotein (LDL) (-40.2 ± 21.3$ vs. -39.3 ± 21.0$, <i>p</i> = 0.634) and the ratio of target LDL attainment (74.2 vs. 79.2$, <i>p</i> = 0.252) were similar between the 2 groups. Low-intensity statins showed comparable LDL cholesterol reduction with moderate-intensity statins both in the elderly and the very elderly groups. The 10-year ASCVD risk reduction was similar between the 2 groups (-3.5 ± 4.9$ vs. -3.0 ± 8.4$, <i>p</i> = 0.480), but in the very elderly group, no different ASCVD reduction rate was shown in low- to high-intensity statins (<i>p</i> = 0.784). Only the elderly group showed a significant correlation (<i>r</i> = 0.112, <i>p</i> = 0.017) with LDL reduction and 10-year ASCVD risk. Interestingly, the incidence of adverse drug reaction (ADR) was higher in the very elderly group (4.4$) than in the elderly group (2.7$) and was more frequent in high-intensity statin therapy.</p><p><strong>Conclusion: </strong>The efficacy of statins in LDL reduction was similar between the elderly and very elderly population. However, the benefit of moderate- to high-intensity statins is limited considering potential ADR. 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Here, we compare the effect of various-intensity statins between elderly and very elderly patients.</p><p><strong>Methods: </strong>43,870 patients over 65 years old who were treated with statins were screened using electronic medical record data.</p><p><strong>Results: </strong>We evaluated 451 patients in the elderly group aged 65-74 years and 159 patients in the very elderly group over 75 years old. Baseline cholesterol profiles were similar between the 2 groups, but the 10-year atherosclerotic cardiovascular disease (ASCVD) risk was significantly higher in the very elderly (20.9 ± 11.5$ vs. 37.2 ± 13.6$, <i>p <</i> 0.001). The reduction rate of low-density lipoprotein (LDL) (-40.2 ± 21.3$ vs. -39.3 ± 21.0$, <i>p</i> = 0.634) and the ratio of target LDL attainment (74.2 vs. 79.2$, <i>p</i> = 0.252) were similar between the 2 groups. Low-intensity statins showed comparable LDL cholesterol reduction with moderate-intensity statins both in the elderly and the very elderly groups. The 10-year ASCVD risk reduction was similar between the 2 groups (-3.5 ± 4.9$ vs. -3.0 ± 8.4$, <i>p</i> = 0.480), but in the very elderly group, no different ASCVD reduction rate was shown in low- to high-intensity statins (<i>p</i> = 0.784). Only the elderly group showed a significant correlation (<i>r</i> = 0.112, <i>p</i> = 0.017) with LDL reduction and 10-year ASCVD risk. Interestingly, the incidence of adverse drug reaction (ADR) was higher in the very elderly group (4.4$) than in the elderly group (2.7$) and was more frequent in high-intensity statin therapy.</p><p><strong>Conclusion: </strong>The efficacy of statins in LDL reduction was similar between the elderly and very elderly population. However, the benefit of moderate- to high-intensity statins is limited considering potential ADR. 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引用次数: 2
摘要
目的:虽然中至高强度他汀类药物治疗越来越多地被推荐用于心血管疾病患者，但其在老年患者中的疗效和安全性尚未得到明确证实。在这里，我们比较了不同强度的他汀类药物对老年和高龄患者的影响。方法:采用电子病历数据对43870例65岁以上接受他汀类药物治疗的患者进行筛选。结果:我们评估了451例65-74岁的老年组和159例75岁以上的高龄组。两组之间的基线胆固醇谱相似，但10年动脉粥样硬化性心血管疾病(ASCVD)风险在老年患者中显著升高(20.9±11.5美元vs. 37.2±13.6美元，p 0.001)。两组低密度脂蛋白(LDL)降低率(-40.2±21.3美元vs -39.3±21.0美元，p = 0.634)和LDL达标率(74.2 vs 79.2美元，p = 0.252)相似。低剂量他汀类药物与中等剂量他汀类药物在老年人和高龄人群中均显示出相当的低密度脂蛋白胆固醇降低效果。10年ASCVD风险降低在两组之间相似(-3.5±4.9美元vs -3.0±8.4美元，p = 0.480)，但在非常老的组中，低强度和高强度他汀类药物的ASCVD降低率没有差异(p = 0.784)。只有老年组与LDL降低和10年ASCVD风险有显著相关性(r = 0.112, p = 0.017)。有趣的是，极老年组的药物不良反应(ADR)发生率(4.4美元)高于老年组(2.7美元)，并且在高强度他汀类药物治疗中更常见。结论:他汀类药物在老年和极老年人群中降低LDL的疗效相似。然而，考虑到潜在的不良反应，中等至高强度他汀类药物的益处有限。因此，尽管他汀类药物的心血管风险较高，但对老年人来说，逐步加强他汀类药物治疗可能是必要的。
High-Intensity Statin Therapy Is "Too Much," Thus Not Indicated for Very Elderly Patients.
Purpose: Although moderate- to high-intensity statin therapy is increasingly recommended in cardiovascular disease patients, the efficacy and safety in elderly patients have not been proven clearly. Here, we compare the effect of various-intensity statins between elderly and very elderly patients.
Methods: 43,870 patients over 65 years old who were treated with statins were screened using electronic medical record data.
Results: We evaluated 451 patients in the elderly group aged 65-74 years and 159 patients in the very elderly group over 75 years old. Baseline cholesterol profiles were similar between the 2 groups, but the 10-year atherosclerotic cardiovascular disease (ASCVD) risk was significantly higher in the very elderly (20.9 ± 11.5$ vs. 37.2 ± 13.6$, p < 0.001). The reduction rate of low-density lipoprotein (LDL) (-40.2 ± 21.3$ vs. -39.3 ± 21.0$, p = 0.634) and the ratio of target LDL attainment (74.2 vs. 79.2$, p = 0.252) were similar between the 2 groups. Low-intensity statins showed comparable LDL cholesterol reduction with moderate-intensity statins both in the elderly and the very elderly groups. The 10-year ASCVD risk reduction was similar between the 2 groups (-3.5 ± 4.9$ vs. -3.0 ± 8.4$, p = 0.480), but in the very elderly group, no different ASCVD reduction rate was shown in low- to high-intensity statins (p = 0.784). Only the elderly group showed a significant correlation (r = 0.112, p = 0.017) with LDL reduction and 10-year ASCVD risk. Interestingly, the incidence of adverse drug reaction (ADR) was higher in the very elderly group (4.4$) than in the elderly group (2.7$) and was more frequent in high-intensity statin therapy.
Conclusion: The efficacy of statins in LDL reduction was similar between the elderly and very elderly population. However, the benefit of moderate- to high-intensity statins is limited considering potential ADR. Therefore, the stepwise intensification of statin therapy might be necessary for the very elderly in spite of the higher cardiovascular risk.
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