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

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。

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.