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Treatment of Cholesterol in the Elderly: Statins and Beyond

  • Nonstatin Drugs (WB Borden, Section Editor)
  • Published:
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Abstract

Lowering of low-density lipoprotein cholesterol levels is a worthwhile intervention in older (more than 65-70 years of age) subjects, since age itself is a powerful predictor of vascular disease risk. Although studies have not consistently demonstrated an overall beneficial effect on total mortality, cardiovascular morbidity and mortality are favorably affected. The drugs most extensively studied are statins, but similar results are at least suggested for other agents. The efficacy, safety, and benefits of statins make them the drugs of choice. Statin intolerance can be managed and should not lead immediately to an abandonment of therapy. In cases in which it cannot be overcome, other lipid-lowering drugs, either singly or in combination, can be used, although their side effects are generally more problematic and their benefits are less prominent. In older patients, prevention of disability from stroke, heart disease, or peripheral vascular diseases may be as important a goal as an overall beneficial effect on mortality, which, in the long run, is unavoidable.

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References

  1. Shepherd J, Blauw G, Murphy M, Ethan, et al. Pravastatin in Elderly Individuals at Risk of Vascular Disease (PROSPER): a randomized controlled trial. Lancet. 2002;360:1623–30.

    Article  CAS  PubMed  Google Scholar 

  2. LaRosa J, He J, Vupputuri S. Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA. 1999;282:2340–6.

    Article  CAS  PubMed  Google Scholar 

  3. Kamai-Bahl S, Burker T, Watson D, Wentworth C. Discontinuation of lipid modifying drugs among commercially insured United States patients in recent clinical practice. Am J Cardiol. 2007;99(4):530–4.

    Article  Google Scholar 

  4. Huseyn N, Jasper B, Ades T. Comparative tolerability and harms of individual statins: a study-level network meta-analysis of 246,955 participants from 135 randomized controlled trials. Circ Cardiovasc Qual Outcomes. 2013;6:390–9. doi:10.1161/CIRCOUTCOMES.111.000071.

    Article  Google Scholar 

  5. Rätz-Bravo A, Tchambaz L, Krähenbühl-Melcher A, et al. Prevalence of potentially severe drug-drug interactions in ambulatory patients with dyslipidemias receiving HMG-CoA reductase inhibitor therapy. Drug Saf. 2005;28(3):263–75.

    Article  PubMed  Google Scholar 

  6. Zhang H, Plutzky J, Skentos H, et al. Discontinuation of statins in routine care settings. Ann Intern Med. 2013;158:526–34.

    Article  PubMed  Google Scholar 

  7. Carter A, Gomes T, Camacho X, et al. Risk of incident diabetes among patients treated with statins: population based study. BMJ. 2013;346:f2610. doi:10.1136/BMJ.f2610.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Axsom K, Berger J, Schartzbard A. Statins and diabetes: the good, the bad, and the unknown. Curr Atherscler Rep. 2013; 299. doi:10.1007/s11883-012-0299-z.

  9. Ko D, Wijeysundera H, Jackevicius CA, et al. Diabetes mellitus and cardiovascular events in older patients with myocardial infarction prescribed intensive-dose and moderate-dose statins. Circ Cardiovasc Qual Outcomes. 2013;6(3):315–22.

    Article  PubMed  Google Scholar 

  10. Afilalo J, Duque G, Steele R, et al. Statins for secondary prevention in elderly patients. J Am Coll Cardiol. 2008;51:37–45.

    Article  CAS  PubMed  Google Scholar 

  11. US Food and Drug Administration. FDA drug safety communication: important safety label changes to cholesterol-lowering statin drugs. http://www.fda.gov/drugs/drugsafety/ucm293101.htm (2012).

  12. Henyan NN, Riche D, East HE, Gann P. Impact of statins on risk of stroke: a meta-analysis. Ann Pharmacother. 2007;41(12):1937–45.

    Article  CAS  PubMed  Google Scholar 

  13. Ginsberg H. Niacin. In: LaRosa J, editor. Practical management of lipid disorders. Fort Lee: Health Care Communications; 1992. p. 49–59.

    Google Scholar 

  14. Canner P, Berge K, Wenger N, et al. Fifteen Year mortality in coronary drug project patients: long-term benefit with niacin. J Am Coll Cardiol. 1986;8:287–94.

    Article  Google Scholar 

  15. Blankenhorn D, Nessin S, Johnson R, et al. Beneficial effects of combined colestipol-niacin on coronary atherosclerosis and coronary venous bypass grafts. JAMA. 1987;257:3233–40.

    Article  CAS  PubMed  Google Scholar 

  16. Brown B, Albers J, Fisher L, et al. Regression of coronary artery disease as a result of intensive lipid lowering in men with high levels of apolipoprotein B. N Engl J Med. 1990;323(19):1289–98.

    Article  CAS  PubMed  Google Scholar 

  17. Brown B, Zhao X, Chait A, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention for coronary disease. N Engl J Med. 2001;345(22):1583–92.

    Article  CAS  PubMed  Google Scholar 

  18. The AIM-HIGH Investigators. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med. 2011;365:2255–67.

    Article  Google Scholar 

  19. Armitage J. Results of the HPS2-THRIVE study. Paper presented at: American College of Cardiology meeting, March 2013.

  20. Gordon D. Bile acid sequestrants. In: LaRosa J, editor. Practical management of lipid disorders. Fort Lee: Health Care Communications; 1992. p. 37–48.

    Google Scholar 

  21. Lipid Research Clinics Program. The Lipid Research Clinics coronary primary prevention results. I. Reduction in incidence of coronary heart disease. JAMA. 1984;251:351–64.

    Article  Google Scholar 

  22. Marrs J. Glucose and low-density lipoprotein cholesterol lowering in elderly patients with type 2 diabetes: focus on combination therapy with colesevelam HCl. Drugs Aging. 2012;29(5):e1–12.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Brown WV. The fibric acid derivatives. In: LaRosa J, editor. Practical management of lipid disorders. Fort Lee: Health Care Communications; 1992. p. 61–74.

    Google Scholar 

  24. Jun M, Foote C, Lv J, et al. Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis. Lancet. 2010;375(9729):1875–84.

    Article  CAS  PubMed  Google Scholar 

  25. Binh A, Dayspring T, Toth P. Ezitimibe therapy: mechanism of action and clinical update. Vasc Health Risk Manag. 2012;8:415–27.

    Google Scholar 

  26. Guyton J. Combination regimens with statin, niacin and intestinally active LDL-lowering drugs: alternatives to statins? Curr Opin Lipidol. 2010;21:372–7.

    Article  CAS  PubMed  Google Scholar 

  27. Rossebø AB, Pedersen TR, Boman B, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008;359:1343–56.

    Article  PubMed  Google Scholar 

  28. The Look Ahead Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369:145–54.

    Article  Google Scholar 

  29. Toth P. Emerging LDL, therapies: mimoperson-antisense oligonucleotide therapy in the management of hypercholesterolemia. J Clin Lipidol. 2013;7(Suppl):S6–10.

    Article  PubMed  Google Scholar 

  30. Goldberg A. Emerging low density lipoprotein therapies: microsomal triglyceride transfer protein inhibitors. J Clin Lipidol. 2013;7(Suppl):S16–20.

    Article  PubMed  Google Scholar 

  31. Davidson M. Emerging low-density lipoprotein therapies: targeting PCSK9 for low-density lipoprotein reduction. J Clin Lipidol. 2013;7(Suppl):S11–6.

    Article  PubMed  Google Scholar 

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Conflict of Interest

John C. LaRosa is a consultant to, has received honoraria from, and has had travel/accommodation expenses covered or reimbursed by Amgen and Pfizer.

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This article does not contain any studies with human or animal subjects performed by the author.

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Correspondence to John C. LaRosa.

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This article is part of the Topical Collection on Nonstatin Drugs

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LaRosa, J.C. Treatment of Cholesterol in the Elderly: Statins and Beyond. Curr Atheroscler Rep 16, 385 (2014). https://doi.org/10.1007/s11883-013-0385-x

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  • DOI: https://doi.org/10.1007/s11883-013-0385-x

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