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BP, cholesterol control most effective strategies for preventing CVD in older adults
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Cholesterol- and BP-lowering therapies are the most effective treatments for reducing CV events in older adults; however, the treatments must be individualized, researchers reported in a literature review published in the Canadian Journal of Cardiology.
“Primary prevention trials in younger populations demonstrate small absolute risk reductions over many years, which is difficult to extrapolate to older patients,” Michelle M. Graham, MD, FRCPC, professor of medicine, division of cardiology at Mazankowski Alberta Heart Institute and University of Alberta Faculty of Medicine and Dentistry, Edmonton, Canada, said in a press release. “Some assume elderly individuals may not have the life expectancy to derive benefit from preventive [CV] therapy; however, their baseline level of risk and subsequent [RR] reduction with appropriate therapy, may actually be higher than in younger patients.”
According to Graham and colleagues, there is no clinical support tool to assess CV risk specifically in older adults due to a lack of data. The American College of Cardiology/American Heart Association guidelines recommend that therapy be individualized based on a discussion of benefit vs. risk, any adverse effects or drug interactions, and patient preference. The Canadian Cardiovascular Society advises physicians to use the Framingham risk score.
The researchers highlighted a few key points in their review:
Statin therapy is effective in reducing risk for MI and stroke in older adults with a life expectancy of 4 years or longer; however, adverse effects and drug interactions should be closely watched in this population due to multiple medications and comorbidities.
A systolic BP between 120 mm Hg and 150 mm Hg is a good target for older patients, but the frailty and comorbidities of each patient should be taken into consideration as well.
Due to lack of evidence of a clinical benefit, antiplatelet therapy should not be used in the primary prevention of CV events.
Smoking cessation, physical activity, maintaining normal BMI and consuming a healthy diet also are effective interventions, although weight loss is not recommended for this population.
Graham and colleagues emphasized the need for more randomized controlled trials, particularly on more intensive BP-lowering therapy. The ongoing STAREE trial, which is comparing atorvastatin with placebo in patients aged at least 70 years, will hopefully offer more insight on statin therapy, the researchers wrote.
“Primary prevention of CVD can improve health and reduce future health care costs. Prevention of a first [CV] event in elderly patients should be individualized based on consideration of the current evidence, as well as goals of therapy, functionality and/or frailty, comorbidities and concomitant medications,” Graham said in the release. – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.
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