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Clinical Information
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Clinical Information
- ACP Journal Club
- ACP Medicine
| ACP Medicine (as of 12/2006): |
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From: VI Diagnosis and Treatment of Dyslipidemia 
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Authors: Brunzell JD et al. |
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"A growing body of evidence from clinical trials indicates that statin therapy is effective in the elderly; lipid-lowering therapy is probably indicated in this population in persons who are at high risk for atherosclerosis or who have preexisting atherosclerosis.73,81 Primary intervention with drug therapy in persons not at high risk for atherosclerosis is controversial. In the PROSPER trial of persons older than 70 years, no benefit was seen with statin therapy in those who did not have preexisting clinical atherosclerosis. Indeed, there was a suggestion of increased gastrointestinal cancer with statin therapy in these elderly patients."
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- MKSAP - does not address lipids in the elderly
- PIER
| PIER (as of 6/27/2007): |
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From: Lipid Disorders (Dyslipidemia) - Screening
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Authors: Pearson TA et al |
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• Screen men and women >65 years who are in generally good health for lipid disorders in conjunction with their overall health care plan.
• Incorporate screening into overall management of the elderly; however, this may not be useful in patients with poor short-term life expectancy.
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- Practice guidelines
| National Guidelines Clearinghouse (as of 7/2007): |
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11 guidelines found
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Results include:
1. VA/DoD clinical practice guideline for the management of dyslipidemia.
• "Elderly patients age 75 or older should be screened if they have multiple CVD risk factors, or a history of CVD and good quality of life with no other major life-limiting diseases."
2. (1)Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). (2)Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines
• "Older adults (men >65 years and women >75 years). Overall, most new coronary heart disease events and most coronary deaths occur in older persons (>65 years). A high level of low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol still carry predictive power for the development of coronary heart disease in older persons. Nevertheless, the finding of advanced subclinical atherosclerosis by noninvasive testing can be helpful for confirming the presence of high risk in older persons. Secondary prevention trials with statins have included a sizable number of older persons, mostly in the age range of 65 to 75 years. In these trials, older persons showed significant risk reduction with statin therapy. Thus, no hard-and-fast age restrictions appear necessary when selecting persons with established coronary heart disease for low-density lipoprotein-lowering therapy. For primary prevention, therapeutic lifestyle changes are the first line of therapy for older persons. However, low-density lipoprotein-lowering drugs can also be considered when older persons are at higher risk because of multiple risk factors or advanced subclinical atherosclerosis."
Searched National Guidelines Clearinghouse :
• Disease/Condition: hyperlipidemia
• Methods Used to Assess the Quality and Strength of the Evidence: Any method other than 'Not stated', or 'Subjective review'.
• Methods Used to Analyze the Evidence: Any method other than 'Not stated', 'Review', or 'Other'
• Methods Used to Formulate the Recommendations: Any method other than 'Not stated', 'Informal Consensus', or 'Other'.
• Age Range: Aged (65 to 79 years), Aged, 80 and over
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- UpToDate
| UpToDate (as of 5/1/2007): |
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From: Treatment of dyslipidemia in the elderly
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Authors: Rosenson RS |
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The decision whether to treat high or high-normal serum cholesterol in an elderly individual needs to be individualized, being based upon both chronological and physiologic age. As an example, a patient with a limited life span from a concomitant illness is probably not a candidate for drug therapy. On the other hand, an otherwise healthy elderly individual should not be denied drug therapy simply on the basis of age alone [2].
The studies described above support the use of lipid lowering therapy for secondary prevention in elderly patients with established CHD who do not have life-limiting comorbid disease...
In comparison, there are limited data concerning the use of lipid lowering for primary prevention of CHD in elderly hypercholesterolemic patients...
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