Primary prevention: do the very elderly require a different approach?
Primary prevention: do the very elderly require a different approach?
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DOI：
10.1016/j.tcm.2014.10.010
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发表时间：
2015-04
影响因子：
9.3
通讯作者：
Schwartz JB
中科院分区：
文献类型：
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作者：
Schwartz JB
最近的心血管疾病预防指南更加强调随机安慰剂对照试验数据作为建议的基础。虽然75岁或80岁以上患者的此类试验数据很少，但数据显示这些老年患者的风险-获益关系发生了变化。一级预防策略决策应考虑估计的预期寿命和总体功能以及心血管事件风险、受益或损害的程度和时间、潜在改变的不良反应特征和知情的患者偏好。数据支持治疗收缩期高血压，以减少估计寿命至少为2年的老年患者的卒中、心血管事件和痴呆，同时调整收缩压目标，并需要更多关注非心血管副作用，如高龄患者的福尔斯。在75岁以上的人群中使用HMG CoA还原酶抑制剂作为一级预防降低升高的胆固醇水平需要更多的个体考虑，因为益处可能不会在3-5年内累积，并且可能会产生不良反应。对于近期心血管（尤其是中风）风险高于副作用风险且估计寿命长于受益时间的功能更高的老年患者，进行降脂治疗是有道理的。阿司匹林具有更高的副作用风险，需要更长的时间才能获得益处。缺乏关于运动干预的试验数据，但在老年患者中已显示出多系统益处，因此运动应成为预防方案的一部分。在非常老的预防性治疗意味着不仅要考虑合并症，多种药物，改变药物的风险-效益关系的医疗问题，但调整目标和方法在整个老年跨度，以保持知情的患者的喜好。
Recent cardiovascular prevention guidelines place a greater emphasis on randomized placebo-controlled trial data as the basis for recommendations. While such trial data are sparse for people over age 75 or 80, data demonstrate altered risk-benefit relationships in these older patients. Primary prevention strategy decisions should consider estimated life expectancy and overall function as well as cardiovascular event risks, magnitude and time to benefit or harm, potentially altered adverse effect profiles, and informed patient preferences. Data support treatment of systolic hypertension to reduce stroke, cardiovascular events and dementia in older patients with at least a 2 year estimated lifespan with modifications in systolic blood pressure goals and a need for greater attention to non-cardiovascular side effects such as falls in the very old. Lowering of elevated cholesterol levels with HMG CoA reductase inhibitors for primary prevention in people over age 75 years requires greater individual considerations as benefits may not accrue for 3–5 years and the potential impact of adverse effects. There is a rationale for lipid lowering treatment in the more highly functional older patient with cardiovascular (especially stroke) risk higher than side effect risks in the near term and with an estimated lifespan longer than the time to benefit. Aspirin has higher side effect risks and requires a longer time to achieve benefit. Trial data are lacking on exercise interventions but multi-system benefits have been shown in older patients such that exercise should be part of a preventive regimen. Preventive therapy in the very old means considering not only medical issues of co-morbidities, polypharmacy, altered risk-benefit relationship of medications but adjusting goals and approaches across the older age span in keeping with informed patient preferences.
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DOI：
10.1177/1740774514537404
发表时间：
2014-10
期刊：
Clinical trials (London, England)
影响因子：
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作者：
Ambrosius WT;Sink KM;Foy CG;Berlowitz DR;Cheung AK;Cushman WC;Fine LJ;Goff DC Jr;Johnson KC;Killeen AA;Lewis CE;Oparil S;Reboussin DM;Rocco MV;Snyder JK;Williamson JD;Wright JT Jr;Whelton PK;SPRINT Study Research Group
通讯作者：
SPRINT Study Research Group
影响因子：
24
作者：
Fihn, Stephan D.;Gardin, Julius M.;Yancy, Clyde W.
通讯作者：
Yancy, Clyde W.
影响因子：
5.9
作者：
Buettner, Catherine;Rippberger, Matthew J.;Smith, Julie K.;Leveille, Suzanne G.;Davis, Roger B.;Mittleman, Murray A.
通讯作者：
Mittleman, Murray A.
影响因子：
37.8
作者：
Fraker, Theodore D., Jr.;Fihn, Stephan D.;Williams, Sankey V.
通讯作者：
Williams, Sankey V.
影响因子：
5.4
作者：
通讯作者：
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