Statins for Primary Prevention in Older Adults: Who Is High Risk, Who Is Old, and What Denotes Primary Prevention?
Authors: Susan J. Zieman
Journal: Annals of Internal Medicine (2010)

Editorials20 April 2010Statins for Primary Prevention in Older Adults: Who Is High Risk, Who Is Old, and What Denotes Primary Prevention?Susan J. Zieman, MD, PhD and Pamela Ouyang, MBBSSusan J. Zieman, MD, PhDFrom Johns Hopkins University School of Medicine, Baltimore, Maryland, 21224, and Johns Hopkins Bayview Medical Center, Baltimore, Maryland, 21224.Search for more papers by this author and Pamela Ouyang, MBBSFrom Johns Hopkins University School of Medicine, Baltimore, Maryland, 21224, and Johns Hopkins Bayview Medical Center, Baltimore, Maryland, 21224.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-8-201004200-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Whether to treat older adults with statin medications for primary prevention of cardiovascular events remains a clinical conundrum. A number of observations with regard to increasing age stoke this dilemma: The association between elevated cholesterol levels and cardiovascular risk diminishes (1), risk-prediction tools (such as the Framingham risk score) become less accurate (2, 3), supporting clinical trial data become limited, and the decreasing life expectancy versus time to medication benefit constantly shifts. Additional downsides of statins for older adults include medication cost, polypharmacy, and possible side effects. Conversely, age alone makes older adults inherently high risk and statins reduce cardiovascular ...References1. Lewington S, Whitlock G, Clarke R, Sherliker P, Emberson J, Halsey J, et al; Prospective Studies Collaboration. 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. 2007;370:1829-39. [PMID: 18061058] CrossrefMedlineGoogle Scholar2. Anderson KM, Wilson PW, Odell PM, Kannel WB. An updated coronary risk profile. A statement for health professionals. Circulation. 1991;83:356-62. [PMID: 1984895] CrossrefMedlineGoogle Scholar3. de Ruijter W, Westendorp RG, Assendelft WJ, den Elzen WP, de Craen AJ, le Cessie S, et al. Use of Framingham risk score and new biomarkers to predict cardiovascular mortality in older people: population based observational cohort study. BMJ. 2009;338:a3083. [PMID: 19131384] CrossrefMedlineGoogle Scholar4. Glynn RJ, Koenig W, Nordestgaard BG, Shepard J, Ridker PM. Rosuvastatin for primary prevention in older persons with elevated C-reactive protein and low to average low-density lipoprotein cholesterol levels: exploratory analysis of a randomized trial. Ann Intern Med. 2010;152:488-96. Google Scholar5. Yusuf S, Lonn E, Bosch J. Lipid lowering for primary prevention. Lancet. 2009;373:1152-5. [PMID: 19345816] CrossrefMedlineGoogle Scholar6. Ridker PM; JUPITER Study Group. Rosuvastatin in the primary prevention of cardiovascular disease among patients with low levels of low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: rationale and design of the JUPITER trial. Circulation. 2003;108:2292-7. [PMID: 14609996] CrossrefMedlineGoogle Scholar7. Mora S, Ridker PM. Justification for the Use of statins in primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER)—can C-reactive protein be used to target statin therapy in primary prevention?. Am J Cardiol. 2006;97:33A-41A. [PMID: 16442935] CrossrefMedlineGoogle Scholar8. Ferrucci L, Corsi A, Lauretani F, Bandinelli S, Bartali B, Taub DD, et al. The origins of age-related proinflammatory state. Blood. 2005;105:2294-9. [PMID: 15572589] CrossrefMedlineGoogle Scholar9. Kritchevsky SB, Cesari M, Pahor M. Inflammatory markers and cardiovascular health in older adults. Cardiovasc Res. 2005;66:265-75. [PMID: 15820195] CrossrefMedlineGoogle Scholar10. Alexander KP, Newby LK, Cannon CP, Armstrong PW, Gibler WB, Rich MW, et al; American Heart Association Council on Clinical Cardiology. Acute coronary care in the elderly, part I: non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation. 2007;115:2549-69. [PMID: 17502590] MedlineGoogle Scholar11. Sever PS, Dahlöf B, Poulter NR, Wedel H, Beevers G, Caulfield M, et al; ASCOT investigators. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet. 2003;361:1149-58. [PMID: 12686036] MedlineGoogle Scholar12. Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM, Cobbe SM, et al; PROSPER study group. PROspective Study of Pravastatin in the Elderly at Risk. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002;360:1623-30. [PMID: 12457784] CrossrefMedlineGoogle Scholar13. Gutterman DD. Silent myocardial ischemia. Circ J. 2009;73:785-97. [PMID: 19282605] CrossrefMedlineGoogle Scholar14. Fleg JL, Gerstenblith G, Zonderman AB, Becker LC, Weisfeldt ML, Costa PT, et al. Prevalence and prognostic significance of exercise-induced silent myocardial ischemia detected by thallium scintigraphy and electrocardiography in asymptomatic volunteers. Circulation. 1990;81:428-36. [PMID: 2297853] CrossrefMedlineGoogle Scholar15. McClelland RL, Chung H, Detrano R, Post W, Kronmal RA. Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2006;113:30-7. [PMID: 16365194] CrossrefMedlineGoogle Scholar16. Elveback L, Lie JT. Continued high incidence of coronary artery disease at autopsy in Olmsted County, Minnesota, 1950 to 1979. Circulation. 1984;70:345-9. [PMID: 6744538] CrossrefMedlineGoogle Scholar17. Helfand M, Buckley DI, Freeman M, Fu R, Rogers K, Fleming C, et al. Emerging risk factors for coronary heart disease: a summary of systematic reviews conducted for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151:496-507. [PMID: 19805772] LinkGoogle Scholar18. Genest J, McPherson R, Frohlich J, Anderson T, Campbell N, Carpentier A, et al. 2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult—2009 recommendations. Can J Cardiol. 2009;25:567-79. [PMID: 19812802] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Johns Hopkins University School of Medicine, Baltimore, Maryland, 21224, and Johns Hopkins Bayview Medical Center, Baltimore, Maryland, 21224.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0521.Corresponding Author: Pamela Ouyang, MBBS, Division of Cardiology, A1-East, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224; e-mail, [email protected]edu.Current Author Addresses: Dr. Zieman: Carnegie 568, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287.Dr. Ouyang: Division of Cardiology, A1-East, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRosuvastatin for Primary Prevention in Older Persons With Elevated C-Reactive Protein and Low to Average Low-Density Lipoprotein Cholesterol Levels: Exploratory Analysis of a Randomized Trial Robert J. Glynn , Wolfgang Koenig , Børge G. Nordestgaard , James Shepherd , and Paul M Ridker Metrics Cited byWhat the Guidelines Do Not Say: Statin Non-benefit GroupsPrimary Prevention of Cardiovascular Disease with Statins in the ElderlyStatins in the primary prevention of cardiovascular diseaseControl de la dislipemia en grupos clínicos especiales: mujeres, ancianos, VIH, enfermedad renal crónica, pacientes con síndrome metabólicoStatin Therapy in Primary Prevention: New Insights Regarding Women and the ElderlyThe treatment of cholesterol: issues, effects and targets 20 April 2010Volume 152, Issue 8Page: 528-530KeywordsAtherosclerosisCardiovascular disease riskCholesterolElderlyHypercholesterolemiaHypertensionMyocardial infarctionStatins ePublished: 20 April 2010 Issue Published: 20 April 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...