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Chapter 33 - Lipid Management

from Section III - Care of the Elderly by Organ System

Published online by Cambridge University Press:  30 June 2022

By
Phil Mendys ,
Adam Moskowitz  and
Ross J. Simpson
Edited by
Jan Busby-Whitehead ,
Samuel C. Durso ,
Christine Arenson ,
Rebecca Elon ,
Mary H. Palmer  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
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Summary

Our understanding of the causal role of serum lipids in atherosclerosis and the development of myocardial infarction and stoke in the elderly is evolving rapidly. We know now that aggressive lipid management can help stabilize atherosclerosis and reduce new and recurrent infarctions in most adults under age 75 and evidence-based guidelines support lipid management with diet, exercise, and medications for older adults under age 75, with the safety and efficacy of statins and now the PCSK-9s well established. For older adults, particularly those under age 85, similar trends persist, but the data is less well established and individualization of therapy with dose adjustment, based on expected quality of life and expected benefit and risks, is encouraged. The availability of newly developed drugs and clinical trials in the elderly to control serum lipids is expected to provide additionally guidance for treatment in older patients in the near future.

Keywords

lipidscardiovascular diseasestatinselderlyrisk–benefitadherence
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 407 - 417
Publisher: Cambridge University Press
Print publication year: 2022

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References

Grundy, SM, Stone, NJ, Bailey, AJ, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019; 139:e1082–e1143.Google Scholar
Enos, WF, Holmes, RH, Beyer, J. Coronary disease among United States soldiers killed in action in Korea. JAMA. 1953; 152:1090–1093.Google Scholar
Berenson, GS, Wattigney, WA, Tracy, RE, et al. Atherosclerosis of the aorta and coronary arteries and cardiovascular risk factors in persons ages 6 to 30 years and studied at necropsy (the Bogalusa Heart Study). American Journal of Cardiology. 1992; 70:851–858.Google Scholar
Cohen, JC, Boerwinkle, E, Mosley, TH Jr, Hobbs, HH. Sequence variations in PCSK9, low LDL, and protection against coronary heart disease. N Eng J Med. 2006; 354(12):1264–1272.CrossRefGoogle ScholarPubMed
Brown, M, Goldstein, J. Lowering LDL – not only how low, but how long? Science. 2006; 311(5768):1721–1723.CrossRefGoogle ScholarPubMed
Ference, BA, Yoo, W, Alesh, I, et al. Effect of long-term exposure to lower low-density lipoprotein cholesterol beginning early in life on the risk of coronary heart disease: A Mendelian randomization analysis. J Am Coll Cardiol. 2012 (Dec.); 60(25):2531–2639.Google Scholar
Robinson, JG, Williams, JK, Gidding, S, et al. Eradicating the burden of atherosclerotic cardiovascular disease by lowering apolipoprotein B lipoproteins earlier in life. Journal of the American Heart Association. 2018; 7:e009778. doi: 10.1161/JAHA.118.009778.CrossRefGoogle ScholarPubMed
National Cholesterol Education Program; National Heart, Lung, and Blood Institute; National Institutes of Health. Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. NIH Publication No. 02–5215. Bethesda, MD: National Cholesterol Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health, 2002.Google Scholar
Kleipool, EEF, et al. Treatment of hypercholesterolemia in older adults calls for a patient-centered approach. Heart. 2020; 106:261–266.Google Scholar
LeMaitre, R, Psaty, BM, Heckbert, SR, et al. Therapy with hydroxylmethylglutaryl coenzyme A reductase inhibitors (statins) and associated risk of incident cardiovascular events in older adults: Evidence from the Cardiovascular Health Study. Arch Int Med. 2002; 162:1395–1400.CrossRefGoogle Scholar
Strandberg, TE, Pyörälä, K, Cook, TJ, et al. Mortality and incidence of cancer during 10-year follow-up of the Scandinavian Simvastatin Survival Study (4S). Lancet. 2004; 364(9436):771–777.Google Scholar
Bulbulia, R, Armitage, J. Does the benefit from statin therapy extend beyond 5 years? Curr Atheroscler Rep. 2013; 15(2):297.Google Scholar
Cholesterol Treatment Trialists’ (CTT) Collaborators, Mihaylova, B, Emberson, J, et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: Meta-analysis of individual data from 27 randomised trials. Lancet. 2012; 380(9841):581–590.Google ScholarPubMed
Grundy, SM, Cleeman, JI. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol. 2004; 44:720–732.Google Scholar
Huddy, K, Dhesi, P, Thompson, PD. Do the frequencies of adverse events increase, decrease, or stay the same with long-term use of statins? Curr Atheroscler Rep. 2013; 15(2):301.Google Scholar
Shepard, J, Blauw, GJ, Murphy, MB, et al. Pravastatin in elderly Individuals at risk of vascular disease (PROSPER): A randomized controlled trial. Lancet. 2002 (Nov. 23); 360(9346):1623–1630.Google Scholar
Sever, PS, Dahlof, B, Poulter, NR, et al. Prevention of coronary ANS stroke events with atorvastatin in hypertensive patients with lower than average cholesterol concentrations in the ASCOT-LLA Trial. Lancet. 2003 (Apr. 5); 361(9364):1149–1158.Google Scholar
Glynn, RJ, Koenig, W, Nordestgaard, B. Rosuvastatin for primary prevention in older individuals with high C-reactive protein and low LDL levels: Exploratory analysis of a randomized trial. Ann Intern Med. 2010; 152(8):488–496, W174.CrossRefGoogle ScholarPubMed
Aronow, WS. Drug treatment of peripheral arterial disease in the elderly. Drugs Aging. 2006; 23(1):1–12.Google Scholar
Sacco, R, Adams, R, Albers, G, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: A statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke. Stroke. 2006; 37:577–617.Google Scholar
The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006; 355:549–559.CrossRefGoogle Scholar
Eckel, R, Jakicic, J, Ard, J, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk. Circulation. 2014; 129(25 Suppl. 2):S76–S99.Google Scholar
US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington, DC: US Department of Health and Human Services, 2008, pp. 1–61. www.health.gov/PAGuidelines.Google Scholar
Pahor M, , et al. Effect of structured physical activity on prevention of major mobility disability in older adults: The LIFE study randomized clinical trial. JAMA. 2014; 311(23):2387–1296.Google Scholar
Newman, C, Preiss, D, Tobert, J, et al. Statin safety and associated adverse events: A scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol. 2019; 39:e38–e81.CrossRefGoogle ScholarPubMed
Navarese EP, , et al. Meta-analysis of impact of different types and doses of statins on new-onset diabetes mellitus. Am J Cardiol. 2013; 111:1123–1130.CrossRefGoogle ScholarPubMed
Thompson PD, , et al. Statin-associated side effects. J Am Coll Cardiol. 2016; 67:2395–2410.Google Scholar
Hey-Hadavi, JH, Kuntze, D, Luo, D. Tolerability of atorvastatin in a population aged > or = 65 years: A retrospective pooled analysis of results from fifty randomized clinical trials. Am J Geriatr Pharmacother. 2006; 4:112–122.Google Scholar
Finegold, J, Manisty, C, Goldacre, B, et al. What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug? Systematic review of randomized placebo-controlled trials to aid individual patient choice. Eur J Prevent Cardiol. 2014; 21(4):464–474.Google Scholar
Kostis, JB. Disputation on the use of age in determining the need for treatment of hypercholesterolemia and hypertension. J Clin Hypertension. 2006; 8(7):519–520.Google Scholar
Cannon, CP, Blazing, MA, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015; 372:2387–2397.CrossRefGoogle ScholarPubMed
Sabatine, MS, Giugliano, RP, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med. 2017; 376:1713–1722.Google Scholar
Bhatt, DL, Steg, PG, et al. Cardiovascular risk reduction with isocosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019; 380:11–22.Google Scholar
Durana, EK, Pradhan, AD. Triglyceride-rich lipoprotein remnants and cardiovascular disease. Clinical Chemistry. 2021; 67(1):183–287.Google Scholar
Chia, L, Schlenk, EA. Effect of personal and cultural beliefs on medication adherence in the elderly. Drugs Aging. 2006; 23(3):191–202.Google Scholar
Higashi, T, Shekelle, PG, Solomon, DH, et al. The quality of pharmacologic care for vulnerable older patients. Ann Intern Med. 2004; 140:714–720.CrossRefGoogle ScholarPubMed
van Driel, ML, et al. Interventions to improve adherence to lipid-lowering medications. Cochrane Database Syst Rev. 2016; 12:CD004371.Google Scholar
Ayanian, JZ, Landrum, MB, McNeil, BJ. Use of cholesterol-lowering therapy by elderly adults after myocardial infarction. Arch Intern Med. 2002; 162:1013–1019.Google Scholar
Ko, DT, Mamdani, M, Alter, D. Lipid-lowering therapy with statins in high-risk elderly patients: The treatment-risk paradox. JAMA. 2004; 291:1864–1870.Google Scholar
Dewilde, S, Carey, IM, Bremner, SA, et al. Evolution of statin prescribing 1994–2001: A case of agism but not of sexism? Heart. 2003; 89:417–421.Google Scholar
Brenner, JS, Glynn, RJ, Mogun, H, et al. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002; 288:445–456.Google Scholar
O’Connor, P. Improving medication adherence: Challenges for physicians, payers, and policy makers. Arch Intern Med. 2006; 166:1802–1804.Google Scholar

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