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Treating Hypercholesterolemia in Older Adults for Primary Prevention of Cardiovascular Events

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Abstract

As the population ages, the demographic of adults aged 75 years and older in the U.S. is projected to grow to 45 million by 2050. Hypercholesterolemia is directly linked to atherosclerotic cardiovascular disease (ASCVD), which remains the leading cause of death in older adults. However, primary prevention of ASCVD through lipid-lowering agents remains unclear among older adults owing to limited involvement of older adults in current trials, lack of dedicated trials, and evidence primarily derived from secondary and retrospective analyses. Therefore, this article aims to (1) review key updates from the latest guidelines on treatment of hypercholesterolemia in older adults, (2) highlight limitations of the current ASCVD risk scores in the geriatric population, (3) present outcomes from key studies on the use of lipid-lowering agents and associated side effects, including a brief review of novel agents such as bempedoic acid, although very few adults over age 75 were included in these trial, and (4) finally, highlight upcoming dedicated trials of statins in older adults for the primary prevention of important geriatric outcomes as well as ASCVD.

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Authors and Affiliations

  1. New England GRECC (Geriatric Research, Education, and Clinical Center), VA Boston Healthcare System, Boston, MA, USA

    Awsse Al-Ani & Ariela R. Orkaby

  2. Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA

    Awsse Al-Ani & Ariela R. Orkaby

  3. Department of Internal Medicine, Yale School of Medicine, Connecticut, USA

    Yasser Jamil

  4. Harvard Medical School, Boston, MA, USA

    Ariela R. Orkaby

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  1. Awsse Al-Ani
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  2. Yasser Jamil
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  3. Ariela R. Orkaby
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Correspondence to Ariela R. Orkaby.

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Awsse Al-Ani, Yasser Jamil, and Ariela R. Orkaby declare no relevant conflicts of interest.

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Dr. Orkaby reports funding from VA CSRD CDA-2 IK2CX001800, and NIA R01AG081287.

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Al-Ani, A., Jamil, Y. & Orkaby, A.R. Treating Hypercholesterolemia in Older Adults for Primary Prevention of Cardiovascular Events. Drugs Aging 41, 699–712 (2024). https://doi.org/10.1007/s40266-024-01139-4

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