Scientific letter
Thoughts on use of statins in geriatric patients
Reflexión sobre el uso de las estatinas en pacientes geriátricos
Eugenia Sopena
, Anna Cortiella, Loreto Veciana, Elena Moltó
Corresponding author
Hospital Sociosanitario Francolí, Tarragona, Spain
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There are questions about the clinical significance of hyperlipidaemia in the population over 80 years of age.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,2</span></a> In secondary prevention clinical trials (CARE, LIPID, PROSPER), the age of the patients included ranges from 58 to 75. In addition, the table system that is currently used to calculate the risk of cardiovascular disease at 10 years limits the age up to 75 (REGICOR) or even 65 (SCORE). The risks of polypharmacy and drug interactions are well known in the elderly.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,4</span></a> Therefore we have decided to conduct this study in order to determine the characteristics of statin therapy in patients over 80 years of age admitted to our hospital.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The study was designed as an observational analysis with a cross section in the Hospital Sociosanitario Francolí of Tarragona. A random day was chosen and a cross-section was performed, collecting data about the usual statin therapy in patients over or equal to 65 years of age. Data collection was conducted anonymously so that, once the data has been collected, it is not possible to relate them to the patient's identity. The day of the cross section there were 160 patients staying in the hospital. A total of 35 patients (22%) were treated with statins. Two patients who were hospitalised the day of the cross-section and were being treated with statins were less than 65 years of age and therefore were not included. The other 33 patients constituted the study population. The median age of these 33 patients was 79 years (range 66–87). Fifteen patients were female (45%). A total of 26 patients (79%) were receiving simvastatin and 7 (21%) were treated with atorvastatin. Twenty-two patients (63%) had dyslipidaemia, 8 (24%) history of heart disease, 9 stroke (27%) and 17 (51%) diabetes mellitus. Seven patients (21%) were receiving statins for primary prevention of dyslipidaemia alone and 2 patients (6%) for diabetes mellitus alone. The age distribution shows that 29 patients (88%) were over 70 years of age and 18 patients (54%) over 80. Of the 18 patients older than 80 (12 women and 6 men), 12 (67%) were receiving treatment for primary prevention of cardiovascular risk. Two patients, one 84 and another 81 years had received statin but did not suffer dyslipidaemia nor were they diabetic or had a history of cardiovascular event.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The results of this study show that a significant percentage of patients over 80 who are admitted to a geriatric hospital are treated with statins and that in more than half of the cases this is done with the intention of being for primary prevention. The geriatric population is a pluripathology population and, in most cases, with polypharmacy, which may increase the risk of adverse effects. Muscle atrophy and the risk of myopathy and rhabdomyolysis should be highlighted out of all the statin-related side effects.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> In the last decades, the survival expectation of the population is increasing progressively.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> The statin treatment indication in primary prevention intends to improve cardiovascular risk within 10 years. The tables currently in use (e.g. REGICOR table) consider age as a risk factor, with 74 as the age limit. There are no tables to assess cardiovascular risk in patients over 75 years of age, although many argue that the data could be extrapolated.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Moreover, it is known that, with age, total cholesterol levels progressively decrease in patients aged between 70 and 90 years, total cholesterol levels are not associated with mortality.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Another important aspect is that, 65% of all patients over 80 years of age who are treated with a statin receive the treatment as primary prevention of cardiovascular risk, which would impact on a long-term benefit. Regarding secondary prevention, the benefit associated with the use of statins in these patients is even clearer.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">As summary, among the geriatric patients admitted to our hospital, nearly a quarter were being treated with statins at the time of admission. We think it is important to consider the characteristics of the geriatric population, side effects of the drugs, potential interactions and potential benefit, which have not yet been studied or proven in any clinical trial in patients older than 80 years.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sopena E, Cortiella A, Veciana L, Moltó E. Reflexión sobre el uso de las estatinas en pacientes geriátricos. Med Clin (Barc). 2015;145:369.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilización de estatinas en geriatría" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Hereu" 1 => "A. 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