Hyperlipidemia in an Otherwise Healthy 80 Year-Old Patient. Theodore D Fraker, Jr, MD Professor of Medicine
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1 Hyperlipidemia in an Otherwise Healthy Theodore D Fraker, Jr, MD Professor of Medicine Orlando, Florida October 7-9, 2011
2 80-Year-Old Patient Primary Prevention Issues in the Elderly: Coronary artery disease Stroke Cancer Dementia Osteoporosis
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5 Leading causes of death at age 80 (men) Heart disease 28.2% Cancer 26.4% COPD 7.1% Stroke 5.6% Diabetes 3.1% Alzheimer s Disease 2.5% CDC 2006 data
6 Framingham Risk Calculator
7 Framingham Risk Calculator
8 Framingham Risk Calculator
9 Framingham Risk Calculator
10 Framingham Risk Calculator
11 Framingham Risk Calculator
12 Pleiotropic effects of statins: Anti-inflammatory effects (reduced hs-crp) Anti-oxidant properties Immunomodulatory effects Anti-thrombotic properties Enhanced vascular reactivity Circulation 2004;109:III-39-43
13 Alleged Benefits of Statins: Reduced cardiac events Reduced risk of stroke Reduced progression of rheumatic aortic stenosis Reduced risk of dementia Reduced risk of osteoporosis Reduced risk of cancer Reduced mortality from sepsis
14 Statin Primary Prevention Trials Jupiter Trial JACC 2011;57:1666
15 Lipid Therapy and Stroke: Meta-Analysis (JACC 2010;56:198)
16 Progression of Rheumatic Aortic Stenosis: 164 patients with aortic peak flow > 1.5 m/sec (mean m/sec in all patients) Patients had a history of rheumatic fever or classic rheumatic mitral valve disease 30 treated with statins; 134 not treated Mean follow-up of years Annual increase in peak velocity m/sec in the statin-treated group; m/sec in the nostatin group Progression of Calcific Aortic Stenosis: no benefit* JACC 2009;53:1874 NEJM 2005;352:2389*
17 Alleged Benefits of Statins: Reduced risk of dementia Reduced intracellular and extracellular amyloid burden in brain tissue (animal models)* Indirect effect via decreasing risk of stroke Rotterdam Study patients enrolled & followed to 2005 Review of pharmacy records Reduced incidence of Alzheimer s Disease (HR 0.57) No benefit from non-statin cholesterol-lowering drugs *Proc Natl Acad Sci USA 2001;98:5856 +J Neurol Neurosurg Psychiatry 2009;80:13
18 Alleged Benefits of Statins: Reduced risk of osteoporosis 5 observational studies suggesting reduced fracture risk for patients on statins 2 observational studies showing no benefit 1 randomized, placebo-controlled trial of 86 postmenopausal women showed no benefit J Bone Miner Res. 2004;19(5):737
19 Alleged Benefits of Statins: Reduced risk of cancer 3 observational studies suggested decreased risk of cancer associated with statin use 5 observational studies showed no benefit Retrospective, propensity-matched analysis of 45,857 patients (GE Centricity database) showed no increased or decreased risk of cancer from statin use* *JACC 2011;58:530
20 Alleged Benefits of Statins: Reduced mortality from sepsis Canadian population-based study showed decreased incidence of sepsis, severe sepsis and fatal sepsis in statin-treated patients (Lancet 2006) Retrospective review of 1041 dialysis pts showed reduced incidence of sepsis in statin-treated pts (JAMA 2007) Meta-analysis of 16 cohort studies showed decreased risk of serious infections in statintreated pts (Arch Int Med 2009)
21 Alleged Benefits of Statins: Reduced cardiac events Reduced risk of stroke Reduced progression of rheumatic aortic stenosis Reduced risk of dementia Reduced risk of osteoporosis Reduced risk of cancer Reduced mortality from sepsis
22 80-Year-Old Patient Primary Prevention of CAD in the Elderly: LDLc : Life-habit changes LDLc : Drug Rx for > 2 risk factors LDLc > 190: Drug Rx
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