Evaluation and Treatment of Older Patients With Hypercholesterolemia

Strandberg, Timo; Kolehmainen, Laura; Vuorio, Alpo

doi:10.1001/jama.2014.10924

Cited by 119 publications

(103 citation statements)

References 61 publications

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“…The decision to initiate a statin in a patient older than 80 years should be made on an individual basis and usually for secondary prevention in a patient with arteriosclerotic cardiovascular disease (ASCVD) and with a life expectancy of more than 5 years. 77,78 Figure. a Describes patients who are healthy in general with no or few comorbidities and functionally independent.…”

Section: Statinsmentioning

confidence: 99%

Polypharmacy in the Aging Patient

Bénétos

Rossignol

Cherubini

et al. 2015

JAMA

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123

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IMPORTANCE Hypertension treatment is beneficial for most hypertensive patients. The benefits for patients who are very old and frail, especially those taking numerous medications, are less certain.OBJECTIVE To provide recommendations for the evaluation and treatment of hypertension among patients aged 80 years and older.EVIDENCE ACQUISITION MEDLINE, PubMed Central, and the Cochrane Database of Systematic Reviews were searched from inception through April 2015, with an emphasis on 2010-2015. Manual cross-referencing of review articles and meta-analyses was also performed to identify randomized controlled trials (RCTs) examining antihypertensive use in octogenarians. The search strategy included the following Medical Subject Headings: hypertension or high blood pressure and trials and oldest old or very old or very elderly.FINDINGS Six post hoc analyses of the previously published Hypertension in the Very Elderly Trial (HYVET) met the inclusion criteria. In the only placebo-controlled RCT on hypertension management in patients older than 80 years (HYVET; N = 3845), the treatment was associated with lower total mortality and key cardiovascular end points but the effect on stroke (fatal and nonfatal), which was the primary outcome, failed to reach the significance level (P = .06). Post hoc analyses of HYVET suggested that active hypertension treatment in very elderly patients was beneficial by reducing blood pressure in individuals with white coat hypertension, showed moderate benefits of the active treatment for cognition, a possible effect for fractures prevention, and sustained differences in reductions of total mortality and cardiovascular mortality in those receiving active treatment. However, patients were community dwelling and less disabled than individuals of the same age in general. CONCLUSIONS AND RELEVANCEHypertensive patients who are healthy, functionally independent, and aged 80 years and older should be treated according to current recommendations for people older than 65 years. There is insufficient evidence regarding the benefits of hypertension treatment for frail polymedicated octogenarians, for whom treatment should be individualized.

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Section: Statinsmentioning

confidence: 99%

Polypharmacy in the Aging Patient

Bénétos

Rossignol

Cherubini

et al. 2015

JAMA

Self Cite

123

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“…1,2 Despite this, the very elderly have the highest rate of statin use in the United States. 3 Given that few studies have investigated the use of statins among this population in a longitudinal manner by vascular disease, we set out to do so.…”

mentioning

confidence: 99%

Statin Use in Very Elderly Individuals, 1999-2012

Johansen

Green

2015

JAMA Intern Med

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“…Interestingly, their pre-planned subgroup analyses demonstrated that the increased risk of short-term mortality differed with respect to age-a higher mortality was associated with morphine use in patients ≤80 years of age, although after morphine administration, advanced age and frailty are factors related to higher mortality. Recently, there is growing evidence that medication effects could differ between younger and elderly patients (20)(21)(22). Although mechanisms that explain the difference in effects of morphine between young and elderly patients in Miró's article (14) remain unknown, it is necessary to remain aware that their conclusion should be applied in patients individually in terms of age or frailty.…”

Section: Editorialmentioning

confidence: 99%