Don’t routinely prescribe lipid lowering drugs in patients with a limited life expectancy

Don’t routinely prescribe lipid lowering drugs in patients with a limited life expectancy

Type of practice

Drugs

Age

Geriatric

Topic Area

Hospital Internal Medicine

Up to one-third of the population aged between 75 and 85 years assumes lipid lowering drugs (mainly statins) for primary or secondary prevention purposes. However, the concept that high LDL-cholesterol and/or low HDL in elderly people are as important cardiovascular risk factors as in younger ages is controversial, being extrapolated; indeed, in the very old people, low LDL-cholesterol correlates with an increased mortality. Above 85 years, the risk/benefit ratio of statins is not obviously a favorable one because, while life expectancy decreases, the incidence of adverse effects (muscular damage, neuropathy, cognitive derangement, falls) becomes relatively greater. In the face of a limited life-expectancy (i.e., less than10 years), starting a therapy with statins is not evidence based, maintaining it, is questionable.

Sources

1. Dalleur O, Spinewinw A, Henrard S, Lousseau C, Speybroeck N, Boland B. Inappropriate prescribing and related hospital admission in frail older persons according to the STOPP and START criteria. Drugs Aging. 2012; 29: 829-37.
2. Schiattarella GG, Perrino C, Magliulo F, et al. Statins and the elderly: recent evidence and current indications. Aging Clin Exp Res 2012; 24(S3): 47-55.
3. Maraldi C, Lattanzio F, Onder G, et al. Variability in the prescription of cardiovascular medications in older patients: correlates and potential explanations. Drugs Aging 2009; 26(Supp l): 41-51.
4. Schatz IJ, Masaki K, Yano K, Chen R, Rodriguez BL, Curb JD. Cholesterol and all cause mortality in elderly peolple from the Honolulu Heart Program: a cohort study. Lancet 2001; 358: 351-5.
5. Petersen LK, Chistensen K, Kragstrup J. Lipid lowering to the end? A review of observational studies and RCT on choletserol and mortality in 80+ year old. Age Ageing 2010; 39: 674-80.

Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.