Researchers Provide Recommendations for Proactive Statin Treatment of Hypercholesterolemia

Internal Medicine World Report, September 2014,

For individuals with hypercholesterolemia, research published in the Journal of American Medical Association provided recommendations on statin use for treating their condition prior to age 80.

For individuals with hypercholesterolemia, research published in the Journal of American Medical Association provided recommendations on statin use for treating their condition prior to age 80.

In a clinical trial, investigators from Finland outlined the medical history of 3 elderly patients who have a history of statin use or coronary conditions.

The first patient identified as Mr. S, was an 89-year-old male with hypertension, coronary artery disease (CAD), and had experienced an acute myocardial infarction when he was 70. In this case, Mr. S, who had experienced chest pain for the past 2 years was prescribed medications, not a statin, to treat his CAD.

Despite subsequent low-density lipoprotein cholesterol levels that was slightly elevated, he was not prescribed a statin due to his old age.

At a hospital visit, 2 months later, Mr. S was diagnosed with a myocardial infarction, heart failure, and an extensive 3-vessel CAD. Despite conservative treatment, he died 2 months later.

The second scenario put forth by researchers involved a 92-year-old man named Mr. J, who developed CAD 30 years prior. For treatment, he underwent a multivessel coronary artery bypass. Post-bypass, Mr. J was prescribed a statin, and he is currently taking atorvastatin, ramipril, and aspirin.

The final case involves Ms. P, an 86 year old woman with a detailed history of hypertension, hypercholesterolemia, type 2 diabetes, and was recently diagnosed with Alzheimer’s disease. Furthermore, a recent ultrasound showed she had atherosclerosis in her carotid arteries.

For some time, Ms. P has been prescribed simvastatin, aspirin, bisoprolol, and felonidipine. In addition, she has recently added to her regimen galantamine, memantine for Alzheimer's disease treatment, quetiapine, mirtazapine, and lorazepam to treat neuropsychiatric symptoms, pantoprazole, a calcium—vitamin D combination, and analgesics.

Despite her cognitive deterioration resulting from Alzheimer’s, Ms. P’s cardiovascular state is stable and her physician has no intention of modifying her treatment.

In addition to the 3 case studies, the investigators underwent a literature review on research involving statin use in prevention of atherosclerotic cardiovascular diseases (ASCVD).

In doing so, they discovered research to support that statin treatment for secondary prevention of ASCVD was effective. Despite the information not being as strong, there was evidence that statins also worked for patients with diabetes, but without the presence of ASCVD. Moreover, they found that although physicians can treat their older patients with statins, there was no strong evidence outlining its benefits.

“Quality of life of even these most vulnerable patients can be better preserved if an ASCVD event is avoided with statin therapy,” the investigators wrote.

While adverse effects tied to statins did not increase in old age, the authors recommended individualized statin implementation plans because of the myriad of medications the elderly tend to be prescribed.