Abstract
Primary prevention of cardiovascular events in older adults is challenging because
of a general paucity of evidence for safe and efficacious therapy. Furthermore, there
is no validated cardiovascular risk assessment tool for older adults (≥75 years of
age), yet most are intermediate-to high-risk. Assessment of cardiovascular risk should
include a discussion of the potential benefits and risks of therapy, and allow for
incorporation of the patients' values and preferences, functionality and/or frailty,
comorbidities, and concomitant medications (eg, polypharmacy, drug-drug interactions,
adherence). The best available evidence for the primary prevention of cardiovascular
events in older adults is for statin therapy and blood pressure control. Statin therapy
reduces the risk of myocardial infarction and stroke, although close monitoring for
adverse events is warranted. Evidence does not support an association between statin
therapy and either cognitive impairment or cancer. Rates of adverse effects, such
as myopathy and diabetes, do not appear to be increased in elderly patients. Blood
pressure control is also paramount to prevent cardiovascular events and mortality
in elderly patients, although the target is debatable and should be individualized
to the patient. Conversely, the benefit of antiplatelet therapy in primary prevention
does not appear to outweigh the risk, and should not be recommended. Other interventions
shown to reduce the risk of cardiovascular disease in elderly patients include smoking
cessation, physical activity, and maintaining a normal body weight.
Résumé
La prévention primaire des événements cardiovasculaires chez les personnes âgées représente
un défi en raison du manque global de données probantes sur l’innocuité et l’efficacité
des traitements. De plus, il n’existe aucun outil d’évaluation validé sur le risque
cardiovasculaire des personnes âgées (≥75 ans); toutefois, la plupart sont exposés
à un risque intermédiaire à élevé. L’évaluation du risque cardiovasculaire devrait
inclure une discussion sur les avantages et les risques potentiels des traitements,
et permettre l’intégration des valeurs et des préférences des patients, la fonctionnalité
et/ou la fragilité, les comorbidités et les médicaments concomitants (par ex. la polypharmacie,
les interactions médicamenteuses, l’observance). Les meilleures données probantes
disponibles sur la prévention primaire des événements cardiovasculaires chez les personnes
âgées concernent le traitement par statines et la maîtrise de la pression artérielle.
Le traitement par statines réduit le risque d’infarctus du myocarde et d’accident
vasculaire cérébral, quoique la surveillance étroite des événements indésirables soit
justifiée. Les données probantes ne corroborent pas l’association entre le traitement
par statines et la détérioration cognitive ou le cancer. La fréquence des effets indésirables,
comme la myopathie et le diabète, ne semble pas être plus élevée chez les patients
âgés. La maîtrise de la pression artérielle est également primordiale pour prévenir
les événements cardiovasculaires et la mortalité chez les patients âgés, bien que
l’objectif soit discutable et qu’il devrait être adapté au patient de manière individuelle.
À l’inverse, comme les avantages du traitement antiplaquettaire en prévention primaire
ne semblent pas l’emporter sur les risques, le traitement ne devrait pas être recommandé.
Les interventions qui ont démontré la réduction du risque de maladies cardiovasculaires
chez les patients âgés sont les suivantes : la désaccoutumance du tabac, l’activité
physique et le maintien d’un poids corporel normal.
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Article info
Publication history
Published online: April 21, 2016
Accepted:
January 27,
2016
Received:
December 14,
2015
Footnotes
See page 1079 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
