Preventive cardiology for the aging population: how can we better design clinical trials of statins?

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Expert Review of Cardiovascular Therapy Pub Date : 2024-01-01 Epub Date: 2024-01-23 DOI:10.1080/14779072.2024.2302122
Anthony S Wierzbicki
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Abstract

Introduction: Older adults form a fast-increasing proportion of the world population. However, gains in increasing quantity of life have not been accompanied by similar gains in quality of life. Older people frequently experience frailty, memory problems, and chronic diseases including cardiovascular disease (CVD) and neurodegenerative diseases. Recent trials have demonstrated the efficacy of anti-hypertensive therapy in older populations but failed to show benefits for aspirin.

Area covered: Statins clearly reduce CVD events in middle-aged populations. There seems to be evidence that the effect is similar in primary prevention older populations based on meta-analyses mainly from sub-groups in large trials, but this becomes less clear with increasing age. However, given differences in drug metabolism and possibly efficacy, competing co-morbidities, their effects on mortality, disability, and dementia in this age group remain to be determined.

Expert opinion: Two large trials are now underway to clarify the role of statin therapy in people aged over 70 years using endpoints of mortality, disability, and neurocognitive endpoints as well as standard cardiovascular disease outcomes. They may provide also provide more evidence on how to approach the over 80 year age group.

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针对老龄人口的预防心脏病学:如何更好地设计他汀类药物的临床试验?
引言老年人在世界人口中所占的比例迅速增加。然而,在提高生活质量的同时,并没有提高生活数量。老年人经常出现虚弱、记忆力衰退以及心血管疾病(CVD)和神经退行性疾病等慢性疾病。最近的试验表明,抗高血压疗法在老年人群中具有疗效,但未能显示出阿司匹林的益处:他汀类药物能明显减少中年人群的心血管疾病事件。根据主要来自大型试验中的亚组的荟萃分析,似乎有证据表明在一级预防的老年人群中效果相似,但随着年龄的增加,效果就不那么明显了。不过,鉴于药物代谢和可能的疗效、并发症等方面的差异,这些药物对这一年龄组的死亡率、残疾和痴呆症的影响仍有待确定:目前正在进行两项大型试验,以明确他汀类药物治疗在 70 岁以上人群中的作用,其终点包括死亡率、残疾和神经认知终点以及标准的心血管疾病结果。这两项试验还将为如何治疗 80 岁以上的老年人提供更多证据。
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来源期刊
Expert Review of Cardiovascular Therapy
Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
0.00%
发文量
82
期刊介绍: Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.
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