Preventing coronary heart disease and stroke with aggressive statin therapy in older adults using a team management model.
OBJECTIVE
The purposes of this review were to highlight recent clinical trial results on the safety and efficacy of statin therapy in adults aged 65 years and older and to examine how nurse practitioners (NPs) and physician assistants (PAs) working together with physicians as a team can better serve the needs of this fastest growing subset of the U.S. population who are at high risk for cardiovascular events including stroke.


METHODS
This report was compiled by reviewing the scientific literature on the safety and efficacy of statin therapy, including effects on cardiovascular, coronary, and stroke endpoints, with particular reference to clinical trial results in older patients.


CONCLUSIONS
Recent guidelines emphasize that age alone is not a reason to withhold treatment with statin therapy in older adults. However, despite the evidence highlighted in this review demonstrating that older patients can safely achieve substantial benefit from statin therapy, studies have consistently shown an inverse relationship between age and treatment propensity. Often, older patients have multiple risk factors and many chronic comorbid conditions that seem to complicate and hinder treatment in many busy clinic practices. More extensive guidelines for the use of statin therapy in older patients, incorporating recommendations for treatment targets and developing a framework for the use of statins in stroke prevention, would assist care providers in the management of this high-risk population. Finally, NPs and PAs are both well educated and well placed to manage patients with chronic stable cardiovascular disease (CVD).


CONCLUSIONS
The implementation of a multidisciplinary team approach to identify at-risk individuals and provide them with education, counseling, and effective statin treatment will aid efforts to reduce the increased risk for morbidity and mortality associated with CVD in older adults.
Mason
Carol M
CM
Division of Preventive Cardiology, USF Heart Health, University of South Florida College of Medicine, Tampa, Florida, USA. cmason@health.usf.edu
D000368:Aged; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control*; D016903:Drug Monitoring; D055317:Evidence-Based Practice; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D017146:Models, Organizational; D009722:Nurse Practitioners / Q000193:education / Q000458:organization & administration*; D009730:Nursing Assessment; D010348:Patient Care Team / Q000458:organization & administration*; D010823:Physician Assistants / Q000193:education / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D024382:Professional Role; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012449:Safety; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors