The need for cholesterol treatment among people over 80 must always be assessed individually by taking into account the patient's overall situation and health. This is the recommendation of Finnish researchers whose review article on the topic will be published on 17 September 2014 in the renowned Journal of the American Medical Association (JAMA).
The number of cholesterol patients over the age of 80 is clearly growing, and cardiovascular diseases in this age group are very common. This has resulted in the need to issue instructions on the use of the most common cholesterol-lowering drugs, statins, in this age group.
"We aim to establish a standard practice of care and to clear up any previous misunderstandings," explains Professor Timo Strandberg of the universities of Helsinki and Oulu.
Controlled trials have shown that lowering cholesterol levels clearly reduces both cardiovascular diseases and mortality in men and women under the age of 80. It is therefore important that patients at increased risk for vascular disease receive treatment sufficiently early, well before they turn 80. The researchers also state that such treatment should not end when the patient turns 80.
No randomised trials have been conducted yet on treatment started after the patient has turned 80. Instead, the commencement of treatment among patients in this age group is based on other data. Statin treatment in the over-80 age group is particularly beneficial to patients who already suffer from a vascular disease.
The researchers stress that the need for cholesterol treatment among those over the age of 80 must always be assessed individually because the health of these patients may vary from excellent to very poor. The average life expectancy of 80-year-olds ranges from eight to ten years. This provides sufficient time for statin treatment to make a difference, and the prevention of cardiovascular diseases clearly improves one's quality of life. Although people over the age of 80 usually tolerate statins well, doses must be moderate.
"Although it is important to respect each patient's view of his or her need for treatment, we must also ensure that patients' decisions regarding treatment are realistic and based on correct information. For example, it is important that patients understand that statins do not cause dementia," Strandberg says.
During treatment, the possible side effects of statins, especially muscle symptoms, must be monitored, and their causes, established. The researchers also point out that elderly patients often use several drugs, so potential drug interactions must also be considered and, if necessary, the treatment regimen must be adjusted.
The review article of the Finnish researchers as well as their instructions for the cholesterol treatment of patients over 80 will be published in JAMA. The topic will also be discussed at the annual conference of the European Union Geriatric Medicine Society (EUGMS) in Rotterdam on 19 September.
The organisations involved in the research include the universities of Helsinki and Oulu, the Hospital District of Helsinki and Uusimaa, the North Karelia Central Hospital, the Finnish Institute of Occupational Health and Mehiläinen Oy.