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Current Drug Treatment of Hyperlipidemia in Older Adults

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Abstract

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death, especially in older adults. Managing modifiable risk factors (e.g., hyperlipidemia, hypertension) remains the primary approach to prevent ASCVD events and ASCVD-related mortality. Statins are generally considered one of the most effective approaches to reduce ASCVD risk, especially for secondary prevention, yet remain underutilized in older adults. The evidence to support statin therapy in older adults is less robust than in their younger counterparts, especially in individuals aged 75 years and older. Recent lipid guidelines have raised this concern, yet statin therapy is recommended in ‘at risk’ older adults. Determining which older adults should receive statin therapy for primary prevention of ASCVD is challenging, as the currently available risk estimation tools are of limited use in those aged over 75 years. Furthermore, non-statin therapies have been de-emphasized in recent clinical practice guidelines and remain understudied in the older adult population. This is unfortunate given that older adults are less likely to tolerate moderate- to high-intensity statins. Non-statin therapies could be viable options in this population if more was understood about their ability to lower ASCVD risk and safety profiles. Nevertheless, lipid-lowering agents remain an integral component of the overall strategy to reduce atherogenic burden in older adults. Future research in this area should aim to enroll more older adults in clinical trials, determine the utility of ASCVD risk estimation for primary prevention, and investigate the role of non-statin therapies in this population.

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Acknowledgments

No funding was received for the preparation of this manuscript. Dave Dixon has received an honorarium from Sanofi US to speak at an educational round table. Dave Dixon is also on the Board of Directors for the Southeast Lipid Association Chapter of the National Lipid Association. None of the other authors have any conflicts of interest that might be relevant to the content of this manuscript.

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  1. Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, PO Box 980533, Richmond, VA, 23298-0533, USA

    Dave L. Dixon, Krista L. Donohoe, Kelechi C. Ogbonna & Sarah M. Barden

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Dixon, D.L., Donohoe, K.L., Ogbonna, K.C. et al. Current Drug Treatment of Hyperlipidemia in Older Adults. Drugs Aging 32, 127–138 (2015). https://doi.org/10.1007/s40266-015-0240-6

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