Abstract
Serum lipid management in patients aged ≥ 75 has not been precisely explored. We, therefore, compared the serum lipid management between the two age groups with and without coronary heart disease (CHD).We, therefore, retrospectively reviewed medical charts of patients who were hospitalized in the departments of internal medicine during a period of 14 months. Serum lipid goal attainment was explored by applying the lipid goals for patients aged < 75 to those aged ≥ 75.In 1988 enrolled patients, 717 subjects (36.1%) were aged ≥ 75. Among them, 41.3% and 32.4% of the patients had CHD, 44.2% and 41.0% were primary prevention at high-risk, and 14.5% and 14.6% were primary prevention at moderate-risk in patients aged ≥ 75 and aged < 75, respectively. Serum LDL-C goal achievement rates in CHD were 66.9% and 65.0% in patients aged ≥ 75 and < 75, respectively (p = 0.334). In the primary prevention at high-risk, these rates were 73.5% and 63.3%, in patients aged ≥ 75 and < 75, respectively (p = 0.001). They were 77.9% and 58.1% in primary prevention at moderate-risk aged ≥ 75 and < 75, respectively (p < 0.001). In CHD, lipid-lowering medication subscription rates were significantly lower in patients aged ≥ 75 (60.1%) than those aged < 75 (73.8%, p < 0.001).In conclusion, in CHD, serum lipid goal attainment was comparable between the two age groups although the lipid-lowering drugs were less frequently prescribed in patients aged ≥ 75. Without CHD, it was significantly better in patients aged ≥ 75 than those aged < 75 although the lipid-lowering drug subscription rates were comparable between the two age groups.
Highlights
The incidence and prevalence of atherosclerotic cardiovascular disease (ACVD) increase with age (de Ruijter et al, 2009; Berthold and Gouni-Berthold, 2011; Phan and Bittner, 2014; McDermott, 2007; Petersen et al, 2005; Rosamond et al, 2007), and the majority of ACVD events occur after age 70 years (Stone et al, 2014)
Shimizu et al / Preventive Medicine Reports 4 (2016) 192–198 shown that cholesterol concentrations retain a significant risk factor for ACVD in the elderly (Benfante and Reed, 1990; Barrett-Connor et al, 1984; Rubin et al, 1990), and lowering serum cholesterol in the elderly may have a greater impact on ACVD than in the middle age people because the absolute attributable risk of ACVD from dyslipidemia is greater in the older age group than in the middle age group, the relative risk of ACVD derived from dyslipidemia is smaller in the older age group than in the middle age group
According to the JAS2012-GL, patients aged ≥75 with dyslipidemia and primary prevention for coronary heart disease (CHD) should be individually treated flexibly by the decisions of their attending physicians based upon the condition of each patient, such as accompanying other chronic diseases, frailty, drug tolerability, and social activities
Summary
The incidence and prevalence of atherosclerotic cardiovascular disease (ACVD) increase with age (de Ruijter et al, 2009; Berthold and Gouni-Berthold, 2011; Phan and Bittner, 2014; McDermott, 2007; Petersen et al, 2005; Rosamond et al, 2007), and the majority of ACVD events occur after age 70 years (Stone et al, 2014). In 2009, the annual mortalities from acute myocardial infarction per 100,000 Japanese population were 12.4 and 18.4 in people aged 50 to years and to 59 years, respectively. The Japan Atherosclerosis Society guidelines for prevention of atherosclerotic cardiovascular diseases 2012 (JAS2012-GL) suggest the following: Subjects with dyslipidemia whose ages are between 65 and 74 should be treated in the same way as those aged below 65 to achieve their serum lipid goals. In cases of subjects with dyslipidemia whose ages are no less than 75 (≥75), patients with primary prevention for coronary heart disease (CHD) can be treated individually by the specific decision of the attending physician, dyslipidemic patients with secondary prevention for CHD should be treated to those whose ages are below 65 to achieve their serum lipid goals (Japan Atherosclerosis Society, 2014). We anticipated that the lipid goal attainment in CHD (secondary prevention) may be similar between patients aged ≥ 75 and b75 and that it may be better in patients aged b75 than in those aged ≥75 whose serum lipid control may not be mandatory in some cases
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