title: Current drug treatment of hyperlipidemia in older adults.
abstract: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death, especially in older adults. Managing modifiable risk factors (e.g., hyperlipidemia, hypertension) remains the primary approach to prevent ASCVD events and ASCVD-related mortality. Statins are generally considered one of the most effective approaches to reduce ASCVD risk, especially for secondary prevention, yet remain underutilized in older adults. The evidence to support statin therapy in older adults is less robust than in their younger counterparts, especially in individuals aged 75 years and older. Recent lipid guidelines have raised this concern, yet statin therapy is recommended in 'at risk' older adults. Determining which older adults should receive statin therapy for primary prevention of ASCVD is challenging, as the currently available risk estimation tools are of limited use in those aged over 75 years. Furthermore, non-statin therapies have been de-emphasized in recent clinical practice guidelines and remain understudied in the older adult population. This is unfortunate given that older adults are less likely to tolerate moderate- to high-intensity statins. Non-statin therapies could be viable options in this population if more was understood about their ability to lower ASCVD risk and safety profiles. Nevertheless, lipid-lowering agents remain an integral component of the overall strategy to reduce atherogenic burden in older adults. Future research in this area should aim to enroll more older adults in clinical trials, determine the utility of ASCVD risk estimation for primary prevention, and investigate the role of non-statin therapies in this population.
authors: Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, PO Box 980533, Richmond, VA, 23298-0533, USA, dldixon@vcu.edu.
authors: Dave L
authors: DL
authors: Dixon
authors: Krista L
authors: KL
authors: Donohoe
authors: Kelechi C
authors: KC
authors: Ogbonna
authors: Sarah M
authors: SM
authors: Barden
mesh_terms: D000368:Aged; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000188:drug therapy*; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
references: Am J Med. 2004 Dec 1;117(11):823-9
references: 15589485
references: Am J Med. 2009 Jan;122(1):73-8
references: 19114174
references: J Clin Lipidol. 2014 Sep-Oct;8(5):473-88
references: 25234560
references: Ann Pharmacother. 2006 Oct;40(10):1880-3
references: 16940411
references: Ann Intern Med. 2010 Apr 20;152(8):488-96, W174
references: 20404379
references: J Pharmacol Exp Ther. 2006 Mar;316(3):1146-52
references: 16282522
references: Aviat Space Environ Med. 2001 Sep;72(9):805-12
references: 11565814
references: J Hypertens. 2011 Mar;29(3):592-9
references: 21297502
references: BMC Geriatr. 2002 Feb 27;2:1
references: 11897015
references: Arch Intern Med. 2006 Mar 27;166(6):605-9
references: 16567597
references: Pharmacotherapy. 2001 Jun;21(6):767-9
references: 11401190
references: N Engl J Med. 2011 Dec 15;365(24):2255-67
references: 22085343
references: JAMA. 1998 May 27;279(20):1615-22
references: 9613910
references: Drugs Aging. 1994 May;4(5):366-78
references: 8043939
references: Am J Geriatr Cardiol. 2003 Jul-Aug;12(4):225-31
references: 12888702
references: J Am Coll Cardiol. 2002 Aug 7;40(3):567-72
references: 12142128
references: JAMA. 2011 Jun 22;305(24):2556-64
references: 21693744
references: Lancet. 2006 Apr 15;367(9518):1262-70
references: 16631882
references: Eur Heart J. 2011 Jul;32(14):1769-818
references: 21712404
references: J Clin Lipidol. 2013 Sep-Oct;7(5):472-83
references: 24079289
references: Int J Clin Pract. 2004 Aug;58(8):777-85
references: 15372851
references: Circulation. 2014 Jun 24;129(25 Suppl 2):S49-73
references: 24222018
references: J Pharmacol Exp Ther. 1993 Dec;267(3):1085-90
references: 8263769
references: Cardiovasc Drugs Ther. 2005 Dec;19(6):403-14
references: 16453090
references: Circulation. 2002 Dec 17;106(25):3143-421
references: 12485966
references: J Clin Lipidol. 2013 Sep-Oct;7(5):484-525
references: 24079290
references: Stroke. 2009 Apr;40(4):1405-9
references: 19228842
references: Am J Cardiol. 2006 Apr 17;97(8A):89C-94C
references: 16581336
references: Am Heart J. 2014 Aug;168(2):205-12.e1
references: 25066560
references: Circulation. 2014 Jan 14;129(2):266-7
references: 24334111
references: Diabetes Care. 2006 Nov;29(11):2378-84
references: 17065671
references: Curr Control Trials Cardiovasc Med. 2001;2(5):205-207
references: 11806796
references: JAMA. 2002 Dec 18;288(23):2998-3007
references: 12479764
references: Am J Cardiol. 2007 Mar 19;99(6A):3C-18C
references: 17368275
references: Pharmacotherapy. 2006 Aug;26(8):1190-2
references: 16863497
references: N Engl J Med. 2005 Apr 7;352(14):1425-35
references: 15755765
references: Lancet. 2004 Mar 6;363(9411):757-67
references: 15016485
references: Am J Med. 2000 May;108(7):538-46
references: 10806282
references: N Engl J Med. 1988 Jul 7;319(1):24-33
references: 3288867
references: Age Ageing. 2007 Nov;36(6):632-8
references: 17881418
references: J Am Geriatr Soc. 2003 May;51(5 Suppl Guidelines):S265-80
references: 12694461
references: J Clin Pharmacol. 1994 Oct;34(10):989-96
references: 7836550
references: J Am Geriatr Soc. 2012 Dec;60(12):2342-56
references: 23106132
references: Pharmacotherapy. 2007 Feb;27(2):183-90
references: 17253908
references: Metabolism. 1991 Dec;40(12):1333-6
references: 1961130
references: N Engl J Med. 2010 Apr 29;362(17):1563-74
references: 20228404
references: Am Fam Physician. 2010 Nov 1;82(9):1056-7
references: 21121548
references: Arch Gerontol Geriatr. 2010 Jan-Feb;50(1):114-8
references: 19217673
references: J Clin Lipidol. 2012 May-Jun;6(3):208-15
references: 22658145
references: J Am Coll Cardiol. 2013 Dec 3;62(22):2090-9
references: 23954343
references: N Engl J Med. 1999 Aug 5;341(6):410-8
references: 10438259
references: Clin Cardiol. 1995 Apr;18(4):209-14
references: 7788948
references: Circulation. 2014 Jun 24;129(25 Suppl 2):S1-45
references: 24222016
references: J Clin Lipidol. 2014 May-Jun;8(3 Suppl):S5-16
references: 24793442
references: Ann Pharmacother. 2012 Apr;46(4):549-57
references: 22474137
references: J Gen Intern Med. 2008 Aug;23(8):1182-6
references: 18449611
references: Circulation. 2002 Nov 19;106(21):2747-57
references: 12438303
references: Lancet. 2010 Feb 27;375(9716):735-42
references: 20167359
references: BMJ. 2009 Jun 30;338:b2376
references: 19567909
references: J Am Geriatr Soc. 1997 Jan;45(1):8-14
references: 8994481
references: Diabetes Care. 2002 Jul;25(7):1250-1
references: 12087035
references: J Clin Lipidol. 2014 May-Jun;8(3 Suppl):S58-71
references: 24793443
references: Eur J Clin Pharmacol. 2006 Apr;62(4):259-65
references: 16489473
references: Ann Intern Med. 2013 Apr 2;158(7):526-34
references: 23546564
references: Ann Intern Med. 1997 Nov 1;127(9):788-95
references: 9382399
references: Curr Diab Rep. 2010 Feb;10(1):70-7
references: 20425070
references: Cardiovasc Hematol Disord Drug Targets. 2011 Mar 1;11(1):17-23
references: 21446900
references: Lancet. 2004 Sep 11-17;364(9438):937-52
references: 15364185
references: J Am Coll Cardiol. 2011 Apr 5;57(14):1535-45
references: 21453832
references: J Clin Lipidol. 2014 May-Jun;8(3 Suppl):S17-29
references: 24793439
references: BMC Geriatr. 2013 May 01;13:41
references: 23634646
references: N Engl J Med. 2012 Jul 26;367(4):309-18
references: 22686415
references: N Engl J Med. 2014 Jul 17;371(3):203-12
references: 25014686
references: Lancet. 2002 Nov 23;360(9346):1623-30
references: 12457784
references: Lancet. 2007 Nov 24;370(9601):1781-90
references: 17559928
references: Drugs Aging. 2011 Sep 1;28(9):681-92
references: 21815708
references: Br J Clin Pharmacol. 1995 Mar;39(3):333-6
references: 7619678
references: J Clin Lipidol. 2014 May-Jun;8(3 Suppl):S1-4
references: 24793438
references: Am Heart J. 2007 Jul;154(1):87-93
references: 17584559
references: Br J Clin Pharmacol. 1994 Mar;37(3):231-6
references: 8198930
references: Diabetes Care. 2006 Jul;29(7):1478-85
references: 16801565
references: J Am Coll Cardiol. 2008 Jan 1;51(1):37-45
references: 18174034
references: Pharmacotherapy. 2003 Jul;23(7):871-80
references: 12885101
references: Muscle Nerve. 2011 Dec;44(6):877-81
references: 22102457
references: Arch Intern Med. 2006 Jun 12;166(11):1232-3; author reply 1233
references: 16772252
references: Ann Intern Med. 2002 Oct 1;137(7):581-5
references: 12353945
references: Am Heart J. 2013 Sep;166(3):597-603
references: 24016512
references: J Pharmacol Exp Ther. 2005 Feb;312(2):786-93
references: 15358814
references: Ther Adv Cardiovasc Dis. 2011 Aug;5(4):199-208
references: 21636623
references: Am J Geriatr Pharmacother. 2012 Oct;10(5):296-302
references: 22921881
references: J Clin Lipidol. 2014 Jan-Feb;8(1):29-60
references: 24528685
references: Lancet. 2005 Nov 26;366(9500):1849-61
references: 16310551
references: Am Heart J. 2014 Jul;168(1):6-15
references: 24952854