他汀在75岁及以上老人进行心血管疾病一级预防的现状

doi:10.12092/j.issn.1009-2501.2020.09.017

中国临床药理学与治疗学 ›› 2020, Vol. 25 ›› Issue (9): 1074-1080.doi: 10.12092/j.issn.1009-2501.2020.09.017

• 综述与讲座 • 上一篇

他汀在75岁及以上老人进行心血管疾病一级预防的现状

杨明¹，董晓雯¹，洪华山^1,2,3

¹福建医科大学附属协和医院老年医学科，福州 350001，福建； ²福建省血管衰老重点实验室，福州 350001，福建； ³福建省老年医学研究所，福州 350001，福建

收稿日期:2020-05-21 修回日期:2020-08-09 出版日期:2020-09-26 发布日期:2020-09-30
通讯作者: 洪华山，男，博士，二级教授，主任医师，博导，研究方向：血管衰老、心力衰竭。 Tel: 0591-83357896 E-mail: 15959159898@163.com
作者简介:杨明，女，本科，副主任医师，研究方向：老年医学。 Tel: 0591-83357896 E-mail: ymdoctor@126.com 董晓雯，女，硕士，主治医师，研究方向：老年医学。 Tel: 0591-83357896 E-mail: 34468644@qq.com
基金资助:
国家临床重点专科建设项目（2013544）；福建省临床重点专科建设项目（2012149）

Statins for primary prevention of atherosclerotic cardiovascular disease in people 75 years of age and older

YANG Ming¹, DONG Xiaowen¹, HONG Huashan ^1,2,3

¹Department of Geriatrics, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China; ²Fujian Key Laboratory of Vascular aging, Fuzhou 350001, Fujian, China; ³ Fujian Institute of Geriatric, Fuzhou 350001, Fujian, China

Received:2020-05-21 Revised:2020-08-09 Online:2020-09-26 Published:2020-09-30

摘要/Abstract

摘要： 他汀是防治动脉粥样硬化性心血管疾病（ASCVD）的重要药物，它在ASCVD二级预防中的作用和地位已经被肯定，但是对老年人是否进行一级预防尚有争议，特别是对于75岁及以上的高龄老人，他汀一级预防的临床证据还不充分，此外，衰弱、多病共存、多重用药、预期寿命有限等特点可能增加他汀不良反应的风险，启动他汀进行一级预防应谨慎。本文通过对近几年老年人群他汀一级预防的临床研究及相关指南进行综述，从“风险-获益”平衡的角度探讨他汀在75岁及以上老人心血管疾病一级预防中的现状，强调在充分评估获益风险比的基础上与患者共同决策，制定他汀个体化治疗策略。

关键词: 他汀, 老年人, 心血管疾病, 一级预防

Abstract: Statins are important drugs for the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). The role and status of statins in ASCVD secondary prevention have been established, but the application of statins in ASCVD primary prevention in the elderly is controversial, especially in the elderly aged 75 years and older. The evidence for primary prevention with statins is not adequate. It should be cautious to initiate statins for primary prevention, because of the frailty, multicomobidity, polypharmacy and the limited life expectancy of the elderly may increase the risk of statins adverse reactions. The recent clinical studies and guidelines of statin primary prevention in the elderly population especially in aged 75 years and older have been reviewed in the paper. Making decisions based on fully evaluating the patients' ratio of benefits and risk with patients and implement statin individualized treatment strategies are emphasized.

Key words: statin, the elderly, atherosclerotic cardiovascular disease (ASCVD), primary prevention

中图分类号:

R541.4

杨明, 董晓雯, 洪华山. 他汀在75岁及以上老人进行心血管疾病一级预防的现状[J]. 中国临床药理学与治疗学, 2020, 25(9): 1074-1080.

YANG Ming, DONG Xiaowen, HONG Huashan. Statins for primary prevention of atherosclerotic cardiovascular disease in people 75 years of age and older[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2020, 25(9): 1074-1080.

参考文献［48］

［1］	Akushevich I, Kravchenko J, Ukraintseva S, et al. Age patterns of incidence of geriatric disease in the U.S. elderly population: Medicare-based analysis ［J］. J Am Geriatr Soc, 2012, 60(2): 323-327.
［2］	Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease.1.Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel ［J］. Eur Heart J, 2017, 38(32): 2459-2472.
［3］	Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomized controlled trial ［J］. Lancet, 2002, 360(9346): 1623-1630.
［4］	Heart Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial ［J］. Lancet, 2002, 360(9326): 7-22.
［5］	Armitage J, Baigent C, Barnes E, et al. Efficacy and safety of statin therapy in older people:a meta-analysis of individual participant data from 28 randomised controlled trials ［J］. Lancet, 2019, 393(10170): 407-415.
［6］	Vallejo-Vaz AJ, Robertson M, Catapano AL, et al. LDL-cholesterol lowering for the primary prevention of cardiovascular disease among men with primary elevations of LDL-cholesterol levels of 190 mg/dL or above: analyses from the WOSCOPS 5-year randomised trial and 20-year observational follow-up ［J］. Circulation, 2017, 136(20): 1-25.
［7］	Sever PS, Dahlof B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA):a multicentre randomized controlled trial ［J］. Lancet, 2003, 361(9364): 1149-1158.
［8］	Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein ［J］. N Engl J Med, 2008, 359(21): 2195-2207.
［9］	Yusuf S, Bosch J, Dagenais G, et al. Cholesterol lowering in intermediate-risk persons without cardiovascular disease ［J］. N Engl J Med, 2016, 374(21): 2021-2031.
［10］	Lemaitre RN, Psaty BM, Heckbert SR, et al. Therapy with hydroxymethylglutaryl coenzyme a reductase inhibitors (statins) and associated risk of incident cardiovascular events in older adults: evidence from the Cardiovascular Health Study ［J］. Arch Intern Med, 2002, 162(12): 1395-1400.
［11］	Ridker PM, Lonn E, Paynter NP, et al. Primary prevention with statin therapy in the elderly: new meta-analyses from the contemporary JUPITER and HOPE-3 randomized trials ［J］. Circulation, 2017, 135(20): 1979-1981.
［12］	McNeil JJ, Woods RL, Nelson MR, et al. Effect of aspirin on disability-free survival in the healthy elderly［J］. N Engl J Med, 2018, 379(16): 1499-1508.
［13］	Zhou Z, Ofori-Asenso R, Curtis AJ, et al. Association of statin use with disability- free survival and cardiovascular disease among healthy older adults ［J］. J Am Coll Cardiol, 2020, 76: 17-27.
［14］	Orkaby AR, Driver JA, Ho YL, et al. Association of Statin use with all-cause and cardiovascular mortality in US veterans 75 years and older ［J］. JAMA, 2020, 324(1): 68-78.
［15］	Kim K, Lee CJ, Shim CY, et al. Statin and clinical outcomes of primary prevention in individuals aged>75 years: the SCOPE-75 study ［J］. Atherosclerosis, 2019, 284: 31-36.
［16］	Ramos R, Comas-Cufí M, Martí-Lluch R, et al. Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study ［J］. BMJ, 2018, 362: 1-12.
［17］	Orkaby AR, Gaziano JM, Djousse L, et al. Statins for primary prevention of cardiovascular events and mortality in older men ［J］. J Am Geriatr Soc, 2017, 65(11): 2362-2368.
［18］	Giral P, Neumann A, Weill A, et al. Cardiovascular effect of discontinuing statins for primary prevention at the age of 75 years: a nationwide population-based cohort study in France ［J］. Eur Heart J, 2019, 40(43): 3516-3525.
［19］	ClinicalTrials.gov. A clinical trial of Statin therapy for reducing events in the elderly (STAREE) ［EB/OL］. (2019-03-12) ［2019-03-12］. https://clinicaltrials. gov/ct2/show/ NCT02099123.
［20］	ClinicalTrials.gov. Statins in the elderly (SITE) ［EB/OL］. ［2020-02-07］. https://clinicaltrials.gov/ct2/ show/NCT02547883.
［21］	Zhou Z, Albarqouni L, Curtis AJ, et al. The safety and tolerability of statin therapy in primary prevention in older adults: a systematic review and meta-analysis ［J］. Drugs Aging, 2020, 37(3): 175-185.
［22］	Newman CB, Preiss D, Tobert JA, et al. Statin safety and associated adverse events: a scientific statement from the american heart association ［J］. Arterioscler Thromb Vasc Biol, 2018, 38: e01-e44.
［23］	Scott D, Blizzard L, Fell J, et al. Statin therapy, muscle function and falls risk in community-dwelling older adults ［J］. QJM, 2009, 102(9): 625-633.
［24］	Glynn RJ, Koenig W, Nordestgaard BG, et al. Rosuvastatin for primary prevention in older persons with elevated C-reactive protein and low to average low-density lipoprotein cholesterol levels: exploratory analysis of a randomized trial ［J］. Ann Intern Med, 2010, 152(8): 488-496,W174.
［25］	Iwere RB, Hewitt J. Myopathy in older people receiving statin therapy:a systematic review and meta-analysis ［J］. Br J Clin Pharmacol, 2015, 80(3): 363-371.
［26］	Guo M, Zhao J, Zhai Y, et al. A prospective study of hepatic safety of statins used in very elderly patients ［J］. BMC Geriatr, 2019, 19(1): 1-7.
［27］	Ridker PM, Pradhan A, MacFadyen JG, et al. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial ［J］. Lancet, 2012, 380: 565-571.
［28］	Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes:a collaborative meta-analysis of randomised statin trials ［J］. Lancet, 2010, 375: 735-742.
［29］	Evans MA, Golomb BA. Statin-associated adverse cognitive effects: survey results from 171 patients ［J］. Pharmacotherapy, 2009, 29(7): 800-811.
［30］	Orsi A, Sherman O, Woldeselassie Z. Simvastatin-associated memory loss ［J］. Pharmacotherapy, 2001, 21(6): 767-769.
［31］	Wagstaff LR, Mitton MW, Arvik BM, et al. Statin-associated memory loss: analysis of 60 case reports and review of the literature ［J］. Pharmacotherapy, 2003, 23(7): 871-880.
［32］	Ott BR, Daiello LA, Dahabreh IJ, et al. Do statins impair cognition? A systematic review and meta-analysis of randomized controlled trials ［J］. J Gen Intern Med, 2015, 30(3): 348-358.
［33］	Samaras K, Makkar SR, Crawford JD, et al. Effects of statins on memory, cognition, and brain volume in the elderly ［J］ .J Am Coll Cardiol, 2019, 74(21): 2554-2568.
［34］	中国老年保健医学研究会, 老年内分泌与代谢病分会, 中国毒理学会临床毒理专业委员会. 老年人多重用药安全管理专家共识［J］. 中国糖尿病杂志, 2018, 26(9): 705-717.
［35］	孙晓琳, 赵娣, 李军袖, 等. 有机阴离子转运多肽OATP1B1、OATP1B3的基因多态性及其介导的药物相互作用研究进展［J］. 中国临床药理学与治疗学, 2015, 20(11): 1296-1301.
［36］	Wiggins BS, Saseen JJ, Page RL, et al. Recommendations for management of clinically significant drug-drug interactions with statins and select agents used in patients with cardiovascular disease: a scientific statement from the American heart association ［J］. Circulation, 2016, 134(21): e1-e28.
［37］	Downs JR, O'Malley PG. Management of dyslipidemia for cardiovascular disease risk reduction: synopsis of the 2014 U.S. department of veterans affairs and U.S. department of defense clinical practice guideline ［J］. Ann Intern Med, 2015, 163(4): 291-297.
［38］	National Institute for Health and Clinical Excellence. Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease ［S］. NICE Clinical Guideline, No.181. London: National Institute for Health and Care Excellence (UK); 2014 07.
［39］	Anderson TJ, Gregoire J, Pearson GJ, et al. 2016 Canadian Cardiovascular Society Guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult ［J］. Can J Cardiol, 2016, 32(11): 1263-1282.
［40］	Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Statin use for the primary prevention of cardiovascular disease in adults: US preventive services task force recommendation statement ［J］. JAMA, 2016, 316(19): 1997-2007.
［41］	Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the american college of cardiology/American Heart Association Task Force on Clinical Practice Guidelines ［J］. J Am Coll Cardiol, 2019, 73(24): e285-350.
［42］	Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease ［J］. Circulation, 2019, 140(11): 1-101.
［43］	Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk ［J］. Eur Heart J, 2020, 41(1): 1-78.
［44］	Mortensen MB, Falk E. Primary prevention with statins in the elderly ［J］. J Am Coll Cardiol, 2018, 71(1): 85-94.
［45］	Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS guidelines for the management of dyslipidaemias ［J］. Eur Heart J, 2016, 37(39): 2999-3058.
［46］	海峡两岸医药卫生交流协会老年医学专业委员会. ≥75岁老年患者血脂异常管理的专家共识［J］. 中国心血管杂志, 2020, 25(3): 201-209.
［47］	Pilotto A, Custodero C, Maggi S, et al. A multidimensional approach to frailty in older people ［J］. Ageing Res Rev, 2020, 60: 1-9.
［48］	陈旭娇, 严静, 王建业, 等. 中华医学会老年医学分会.老年综合评估技术应用中国专家共识［J］. 中华老年医学杂志, 2017, 36(5): 471-477.

[1]	李青华, 赵艳, 赵海港, 高朋飞, 徐炳欣. ABCB1 G2677T 基因多态性检测在缺血性脑卒中患者应用阿托伐他汀降脂治疗中的价值[J]. 中国临床药理学与治疗学, 2023, 28(6): 633-640.
[2]	赵璐, 李付勇, 温滨红, 李道伟. 他汀类药物治疗伴高脂血症偏头痛患者的临床疗效分析[J]. 中国临床药理学与治疗学, 2023, 28(6): 671-675.
[3]	叶红波, 宋洋洋, 薛领, 芮建中. 基于模型的Meta分析建立中国老年人群美罗培南群体药动学模型[J]. 中国临床药理学与治疗学, 2022, 27(9): 984-990.
[4]	梁美芳, 陈庆状, 杨沛群, 王勇. 基于真实世界的阿托伐他汀仿制药和原研药防治缺血性脑卒中/短暂性脑缺血发作的有效性和安全性比较[J]. 中国临床药理学与治疗学, 2022, 27(7): 785-792.
[5]	曾晓凡, 许宜琪, 刘书, 吴茜, 李自保, 何俊俊, 金岳龙, 赵永莉, 何春玲, 高家林. 回顾性分析小剂量阿司匹林对2型糖尿病病人非致死性心梗和脑梗一级预防的作用[J]. 中国临床药理学与治疗学, 2022, 27(6): 665-671.
[6]	蔡子纯, 蒋元桢, 张春生, 李纪明. 环状RNA在心血管疾病中的研究进展及应用前景[J]. 中国临床药理学与治疗学, 2022, 27(4): 397-404.
[7]	云强, 董雪佳, 王梦娇, 刘雅虹, 王智光, 江名芳. 瑞舒伐他汀通过UCP2-SIRT3信号调控脑I/R对神经元的损伤[J]. 中国临床药理学与治疗学, 2021, 26(2): 144-153.
[8]	王凤玲, 孟祥云, 陈正徐, 曹荣娟, 何争民, 叶茜, 王聪, 李琪. 安徽地区汉族心血管疾病患者SLCO1B1与ApoE基因多态性分布及其在他汀类药物临床个体化应用中的意义[J]. 中国临床药理学与治疗学, 2021, 26(1): 40-48.
[9]	徐永霞, 谢明珠, 宫牧雪, 黄嘉莹, 赵丽, 朱德发. 25羟维生素D对老年2型糖尿病患者胰岛β细胞功能的影响[J]. 中国临床药理学与治疗学, 2020, 25(9): 1021-1026.
[10]	阎雨, 刘康, 连雯雯, 张臻, 赫军. 肠道菌群在心血管疾病及治疗中的研究进展[J]. 中国临床药理学与治疗学, 2020, 25(7): 829-834.
[11]	谢祥妹，黄志红，刘小菊，薛冰，蓝保珠. 叶酸片联合阿托伐他汀治疗对H型高血压患者同型半胱氨酸及颈动脉粥样硬化的影响[J]. 中国临床药理学与治疗学, 2020, 25(4): 455-459.
[12]	李佳丹，鲁琛. 桑白皮生物碱与辛伐他汀联用对高脂血症大鼠作用研究[J]. 中国临床药理学与治疗学, 2020, 25(3): 278-284.
[13]	曹莹, 王文萍, 李晓斌, 王华伟, 隋鑫, 喻明, 陈璐, 窦晓燕, 吴秀君, 马然, 李美烨, 高雪. 瑞舒伐他汀钙片在中国健康受试者的生物等效性研究[J]. 中国临床药理学与治疗学, 2020, 25(12): 1369-1375.
[14]	孙青, 孙建芳, 李力, 常会超, 周权. 五酯胶囊对大鼠体内辛伐他汀及其代谢物辛伐他汀酸药代动力学影响[J]. 中国临床药理学与治疗学, 2020, 25(11): 1242-1249.
[15]	黄立佳，黄杨，孔劲松，郑鑫，宫小康，阮建伟，王海宝. 阿托伐他汀钙经STAT1-caspase-3信号轴抑制膝骨关节炎大鼠关节软骨退变的研究[J]. 中国临床药理学与治疗学, 2018, 23(7): 743-748.

他汀在75岁及以上老人进行心血管疾病一级预防的现状

Statins for primary prevention of atherosclerotic cardiovascular disease in people 75 years of age and older

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献［48］

相关文章 15

编辑推荐

Metrics

本文评价

他汀在75岁及以上老人进行心血管疾病一级预防的现状

Statins for primary prevention of atherosclerotic cardiovascular disease in people 75 years of age and older

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 ［48］

相关文章 15

编辑推荐

Metrics

本文评价

参考文献［48］