Keeping up-to-date on lipid-lowering drugs.

Abstract

Geriatric Nursing Volume 25 Number 4 Since publication of the last drug consult column on lipid-lowering drugs 3 years ago,1 2 new drugs are being used for dyslipidemia, and the evidence supporting the use of drugs for dyslipidemia is mounting. Of particular interest for nurses working with older adults is information from recent clinical trials with large numbers of older adults to address questions about upper age limits for the benefits of lipid-lowering drugs. A recent review of such clinical trials concluded that “the notion that drug interventions are of no value in older patients should be abandoned.”2 Thus, gerontologic nurses need to keep up to date on the latest evidence-based recommendations for treatment of dyslipidemia and on information about lipidlowering drugs for older adults. Dyslipidemia, defined as abnormal serum lipoprotein levels, is a risk factor for cardiovascular disease when lowdensity lipoprotein (LDL) cholesterol levels are high or high-density lipoprotein (HDL) cholesterol levels are low. In 2001, the National Cholesterol Education Program published the Adult Treatment Panel (ATP III) guidelines for identifying and treating dyslipidemia,3 and these recommendations have been widely used for 3 years. The ATP III paid particular attention to people aged 50 years and older and encouraged health care providers to consider a number of risk factors for people of any age when evaluating the need for interventions. In contrast to previous reports that determined risk based partially on the ratio between LDL and HDL cholesterol, the updated report recognizes that HDL cholesterol should be maintained above 60 mg/dL, and LDL cholesterol should be low regardless of any ratio. For example, the LDL goal for healthy people with no risk factors is <160 mg/dL, but the LDL goal for someone with multiple risks is <100 mg/dL. The ATP III identifies the following conditions as risk factors: • Cardiovascular disease (e.g., angina, angioplasty, bypass surgery) • Cerebrovascular conditions (e.g., ischemic stroke, transient ischemic attacks, symptomatic carotid artery stenosis) • Peripheral vascular conditions • Diabetes mellitus The report categorizes 3 levels of risk and recommends acceptable lipoprotein ranges according to the person’s Keeping Up-to-Date on Lipid-Lowering Drugs