Zusammenfassung
Kardiovaskuläre Erkrankungen stellen auch bei älteren Menschen die häufigste Todesursache dar. Invasive diagnostische und therapeutische Interventionen werden in zunehmendem Maß bei älteren Patienten durchgeführt, um die Funktionalität und damit eine gute Lebensqualität zu erhalten. Präventivmedizinische Maßnahmen, wie die lipidsenkende Therapie, reduzieren die kardiovaskuläre Ereignisrate und sind deshalb auch bei älteren Menschen von Bedeutung. Unter Statintherapie sollten hinsichtlich des Nebenwirkungsprofils Arzneimittelinteraktionen wie auch die Myopathie besonders beachtet werden. Bezüglich der Einflussnahme der Statine auf die kognitive Leistungsfähigkeit liegen zum Teil divergente Ergebnisse vor. Retrospektive Analysen weisen auf ein erhöhtes Risiko zur Manifestation eines Typ-2-Diabetes in Risikogruppen hin. Die Indikationsstellung zur Statintherapie sollte das Risikoprofil und die individuelle Situation des älteren Patienten berücksichtigen.
Abstract
Cardiovascular disease is also the most frequent cause of mortality in the elderly population. Invasive diagnostic and therapeutic interventions are performed at an increasing rate in older patients in order to maintain functional capacities and, thus, an adequate quality of life. Thus, strategies to prevent cardiovascular events (e.g., lipid lowering therapy) are also of great importance in elderly. With respect to the side effects of statin therapy, the risk of drug interaction has to be considered, as well as myopathy. Discrepant study results exist about the influence of statins on cognitive function. Retrospective analyses indicate that statin therapy might be related to an increased risk for type 2 diabetes in certain risk groups. The indication for statin therapy should, therefore, consider the risk profile and especially the individual situation of the older patient.
Literatur
Afilalo J, Duque G, Steele R et al (2008) Statins for secondary prevention in elderly patients: a hierarchical bayesian meta-analysis. J Am Coll Cardiol 51:37–45
Alonzo CB (2011) Myths and facts concerning the use of statin in very old patients. Cardiovasc Haematol Disord Drug Targets 11:17–23
American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2013) Executive summary: heart disease and stroke statistics-2013 update: a report from the American Heart Association. Circulation 127:143–152
Aronow WS (1996) Risk factors for new coronary events in a large cohort of very elderly patients with and without coronary artery disease. Am J Cardiol 77:864–866
Baigent C, Keech A, Kearny PM et al (2005) Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised statin trials. Lancet 366:1267–1278
Berr JD, Dyer A, Cai X et al (2012) Lifetime risk of cardiovascular diseases. N Engl J Med 366:321–329
Berthold HK, Gouni-Berthold I (2011) Lipid-lowering drug therapy in elderly patients. Curr Pharm Dis 17:877–893
Bottorff MB (2006) Statin safety and drug interactions: clinical significance. Am J Cardiol 97:276–312
Boyd CH, Vollenweider D, Puman MA (2012) Informing evidence-based decision-making for patients with comorbidity: availability of increasing information in clinical trials for chronic disease. PLoS ONE (E-pub ahead of print)
Carriere I, Dupuy AM, Lacroux A et al (2008) Biomarkers of inflammation and malnutrition associated with early death in healthy elderly people. J Am Geriatr Soc 56:840–846
Casiglia E, Mazza A, Tikhoff V et al (2003) Total cholesterol and mortality risk in the elderly. J Int Med 254:353–364
Cholesterol Treatment Trialists (CTT) Collaborators (2012) 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 380:581–590
Choskshi NP, Messerli FH, Sutin D et al (2012) Appropriateness of statin in patients ages ≥ 80 years and comparison to other age groups. Am J Cardiol 110:1477–1481
Corti MC, Guralnik JM, Salive ME et al (1997) Clarifying the direct relation between total cholesterol levels and deaths from coronary heart disease in older persons. Ann Intern Med 126:753–760
Dobkin BH (2005) Underappreciated statin-induced myopathy weakness causes disability. Neurorehabil Neural Repair 19:259–263
Dzien A, Winner H, Theurl E et al (2013) Fat-free mass and fasting glucose values in patients with and without statin therapy assigned to age groups between < 60 and > 75 years. Obes Facts 6:9–16
Farnier M, Bruckert E (2012) Severe familial hypercholesterolaemia: current and future management. Arch Cardiovasc Dis 105:656–665
Farzadfar F, Finucane MM, Danaei G et al (2011) National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3.0 million participants. Lancet 377:578–586
Ferrara A, Barrett-Connor E, Shan J (1997) Total, LDL, and HDL-cholesterol decrease with age in older men and women. The Rancho Bernardo Study 1984–1994. Circulation 96:37–48
Gargiulo G, Giugliano G, Brevetti L, Sannino A et al (2012) Use of statis in lower extremity artery disease: a review. BMC Surg 12(Suppl 1):S15
Ghosh S, Aronow WS (2003) Utilization of lipid-lowering drugs in elderly persons with increased serum low-density lipoprotein cholesterol associated with coronary artery disease, symptomatic peripheral arterial disease, prior stroke, or diabetes mellitus before and after an educational program on dyslipidemia treatement. J Gerontol A Biol Sci Med Sci 58:M432–M435
Goldstein MR, Mascitelli L (2013) Do statins cause diabetes? Curr Diab Rep (E-pub ahead of print)
Gotto AM Jr (2007) Statintherapy and the elderly. SAGE advice? Circulation 115:681–683
Gotto AM Jr, Moon JE (2012) Management of cardiovascular risk: the importance of meeting lipid targets. Am J Cardiol 110:3A–14A
Grundy SM, Cleeman JI, Rifkinf BM et al (1999) Cholesterol lowering in the elderly population. Arch Intern Med 159:1670–1678
Grundy SM, Cleeman JL, Merz NB, Brewer B et al (2004) Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Atherosclerosis 24:e149–e161
Heart Protection Study Collaborative Group (2011) Effects on 11-year mortality and morbidity for lowering LDL-cholesterol with simvastatin for about 5 years in 20,536 high-risk individuals: a randomised controlled trial. Lancet 378:2013–2020
Huisa BN, Stemer AB, Zivin JA (2010) Atorvastatin in stroke: a review of SPARCL and subgroup analysis. Vasc Health Risk Manag 6:229–236
Hunt D, Young P, Simes J et al (2001) Benefits of pravastatin on cardiovascular events and mortality in older patients with coronary heart disease are equal to or exceed those seen in young patients: results from the LIPID trial. Ann Intern Med 134:931–940
Jackson R, Lawes CMM, Bennett DA et al (2005) Treatment with drugs to lower blood pressure and blood cholesterol based on an individual’s absolute cardiovascular risk. Lancet 365:434–441
Jick H, Zornberg GL, JIck SS et al (2000) Statins and the risk of dementia. Lancet 356:1627–1630
Johnman C, Mackay DF, Olroyd K, Pell JP (2013) Quality of life following percutaneous coronary interventions in octogenerians: a systematic review. Heart (E-pub ahead of print)
Kanter MM, Kris-Etherton PM, Fernandez ML et al (2012) Exploring the factors that affect blood cholesterol and heart disease: is dietary cholesterol as bad for you as history leads us to believe? Adv Nutr 3:711–717
Kini AS, Baber U, Kovacic JE, Limaye A et al (2013) Changes in plaque lipid content after short-term intensive versus standard statin therapy: the YELLOW trail. J Am Coll Cardiol (E-pub ahead of print)
Knoops KT, Groot LC de, Kromhout D et al (2004) Mediterranean diet, life-style factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292:1433–1439
Leung A, Schaeffer EW, Tempelhof MV, Stone NJ (2012) Emphasizing statin safety in the hospitalized patient: a review. Am J Med 125:845–853
Manktelow BN, Potter JF (2009) Interventions in the management of serum lipids for preventing stroke recurrence. Cochrane Database Syst Rev 8:CD002091
Marcum ZA, Vandegried JP, Linnebur SA (2012) FDA drug safety communications: a narrative review and clinical considerations for older adults. Am J Geriatr Pharmacother 10:264–271
McGuiness B, Craig D, Bullock R, Passmore P (2009) Statins for the prevention of dementia. Cochrane Database Syst Rev 15:CD003160
Nash DT (2003) Statins. Evidence of effectiveness in older patients. Geriatrics 58:39–42
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High blood Cholesterol in adults (Adult Treatment Panel III) (2002) Third report of the National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation and treatment of high blood cholesterol in adults – final report. Circulation 106:3143–3421
Ni Chroinin D, Asplund K, Asberg S, Callaly S et al (2013) Statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and randomized trials. Stroke 44:448–456
Padala KP, Padala PR, McNeilly DP et al (2012) The effect of HMG-Co-A reductase inhibitors on cognition in patients with Alzheimer’s disease: a prospective withdrawl and rechallenge pilot study. Am J Geriatr Pharmacother 10:296–302
Patel AB, Kostis JB, Wilson AC et al (2008) Long-term fatal outcomes in subjects with stroke or transient ischemic attack: fourteen-year follow-up of the systolic hypertension in the elderly program. Stroke 39:1084–1089
Perk J, DeBacker G, Gohlke H et al (2012) European guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J 33:1635–1701
Petersen LK, Christensen K, Kragstrup J (2010) Lipid lowering treatment to the end? A review of observational studies and RCTs on cholesterol and mortality in 80 + year olds. Age Ageing 39:674–680
Prospective Studies Collaboration, Lewington S, Whitlock G et al (2007) Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 37:1829–1839
Redelmeier DA, Thiruchelvam D, Danman N (2008) Delirium after elective surgery among elderly patients taking statins. CMAJ 179:645–652
Rockwood K, Kirkland S, Hogan DB, Mac Knight C et al (2002) Use of lipid-lowering agents, indication bias, and the risk of dementia in community-dwelling elderly people. Arch Neurol 59:223–227
Saely CH, Drexel H (2013) Is type 2 diabetes really a coronary heart disease risk equivalent? Vascul Pharmacol (E-pub ahead of print)
Sampson U, Linton MF, Fazio S (2011) Are statins diabetogenic? Curr Opin Cardiol 26:342–347
Sheperd J, Blauw GJ, Murphy MB et al (2002) Pravastatin in elderly individuals at risk for vascular disease (PROSPER). A randomised controlled trial. Lancet 360:1623–1630
Sparks DL, Kryscio RJ, Sabbagh MN et al (2008) Reduced risk of incident AD with elective statin use in a clinical trial cohort. Curr Alzheimer Res 5:416–421
Taylor F, Huffmann MD, Macedo AF et al (2013) Statins for the primary prevention of cardiovascular diseases. Cochrane Database Syst Rev 1:CD004816
Terry DF, Evans JC, Pencina MJ, Murabito JM et al (2007) Characteristics of Framingham offspring participants with long-lived parents. Arch Intern Med 167:438–444
Thompson PD, Clarkson P, Karas RH (2003) Statin associated myopathy. JAMA 13:1681–1690
Upmeier E, Korhonen MJ, Melin-Salmivaara A, Huupponen R (2013) Statin use among older Fins stratified according to cardiovascular risk. Eur J Clin Pharmacol 69:261–267
Vliet P van, Water W van de, Craen AJ de, Westendorp RG (2009) The influence of age on the association between cholesterol and cognitive function. Exp Gerontol 44:112–122
Vischer UM, Frangos E, Graf C et al (2012) The prognostic significance of malnutrition as assessed by the Mini Nutritional Assessment (MNA) in older hospitalized patients with heavy disease burden. Clin Nutr 31:113–117
Vogt A, Nieczaj R, Thomas HP et al (2002) Primary and secondary prevention in dyslipidemia in the elderly. Ther Umsch 59:341–344
Volkert D, Saeglitz C, Gueldenzoph H et al (2010) Undiagnosed malnutrition and nutrition-related problems in geriatric patients. J Nutr Health Aging 14:387–392
Volpato S, Ble A, Metter EJ et al (2008) High-density lipoprotein cholesterol and objective measures of lower extremity performance in older nondisabled persons: the InChianti study. J Am Geriatr Soc 56:621–629
Weijnberg MP, Feskens EJ, Kromhout D (1996) Total and high density lipoprotein cholesterol as risk factors for coronary heart disease in elderly men during 5 years of follow up. The Zutphen Elderly Study. Am J Epidemiol 143:151–158
Weverling-Rijnsburger AW, Jonkers IJ, Exel E van et al (2003) High-density vs low density lipoprotein cholesterol as the risk factor for coronary artery disease and stroke in old age. Arch Intern Med 163:1549–1554
Yusuf S, Lonn E, Bosch J (2009) Lipid lowering for primary prevention. Lancet 373:1152–1155
Cholesterol Treatment Trialists‘ (CTT) Collaboration et al (2010) Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 376:1670–1681
Brugts JJ, Yetgin T, Hoeks SE et al (2009) The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 338:b2376
Lewis SJ, Moye LA, Sacks FM et al (1998) Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range. Results of the Cholesterol and Recurrent Events (CARE) trial. Ann Intern Med 129:681–689
Gränsbo K, Melander O, Wallentin L et al (2010) Cardiovascular and cancer mortality in very elderly post-myocardial infarction patients receiving statin treatment. J Am Coll Cardiol 55:1362–1369
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Lechleitner, M. Lipidsenkende Therapie bei geriatrischen Patienten. Z Gerontol Geriat 46, 577–587 (2013). https://doi.org/10.1007/s00391-013-0516-6
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DOI: https://doi.org/10.1007/s00391-013-0516-6