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Resumen
Los estudios de población adulta, que incluían cierto número de personas mayores, demostraron una inexistente o débil correlación en el binomio colesterol-enfermedad cardiovascular en la tercera edad. Aquellos que incluyeron un considerable volumen de personas en esas franjas de edad sí encontraban una importante relación; incluso al considerar el riesgo absoluto, no el relativo, éste era mayor en este grupo de población. Hay estudios que indican que la relación desaparece por encima de los 85 años de edad, y algunos dudan si se mantiene por encima de los 75 años.
Los grandes estudios prospectivos de intervención farmacológica indican que el tratamiento hipolipemiante en la tercera edad es tan eficaz como en los adultos más jóvenes. Sin embargo, y dado que el análisis de esta franja de edad se hizo retrospectivamente, y con un número pequeño de personas, hay en marcha varios estudios con distintas estatinas para establecer la eficacia y la oportunidad de tratar la hiperlipemia en la tercera edad. Los análisis costo-beneficio post-hoc disponibles con estatinas referidos a la tercera edad, indican que su uso estaría justificado.
Finalmente se revisan las opciones farmacológicas disponibles en la actualidad: estatinas, resinas y fibratos. La mayor potencia hipolipemiante de las primeras, y su tolerancia, hacen que sean de elección en el tratamiento de las hipercolesterolemias puras o asociadas con hipertrigliceridemias moderadas. En las hipertrigliceridemias puras o asociadas con una hipercolesterolemia leve, los fibratos son la primera elección. Se recuerda la importancia de ajustar las dosis de los fármacos en función de la función renal y/o hepática en esta edad, en la que es frecuente una insuficiencia real o funcional de los sistemas corporales de eliminación.
Palabras clave:
Hipercolesterolemia
Hiperlipidemia
Ancianos
Tercera edad
Estatinas
Summary
Studies of the adult population, that included some elderly subjects demonstrated a non-existing or weak correlation in the cholesterolcardiovascular disease relation in the elderly. Those including a considerable volume of persons in these age groups found a significant relationship; this was greater in the population group even when the absolute risk and not the relative one was considered. There are studies that indicate that this relationship disappears over the age of 85, and some doubt if it is maintained above age 75.
The large prospective studies on drug intervention indicate that hypolipemic drug treatment in the elderly is as efficient as in the younger adults. However, and given that the analysis of this age group was performed retrospectively, and with a small number of persons, there are several studies underway with different statins to establish the efficacy and usefulness of treating hyperlipemia in the elderly. The «post-hoc» cost-benefit analysis with statins in regards to the elderly age indicates that their use would be justified.
Finally, the pharmacological options presently available are reviewed: statins, resins and fibrates. The greater hypolipemic potency of the first ones and their tolerability make them the treatment of choice for the pure hypercholesterolemias or those associated with moderate hypertriglyceridemias. In the pure hypertriglyiceridemias or those associated with a mild hypercholesterolemia, the fibrates are the first choice treatment. The importance of adjusting the drug doses in function of the renal and/or hepatic function in this age, in which real or functional failure of the elimination body systems is frequent, is emphasized.
Key words:
Hypercholesterolemia
Hyperlipidemia
Elderly
Statins
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