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Canadian Journal of Cardiology

Primary Prevention of Cardiovascular Disease in Older Adults

Published:April 21, 2016DOI:https://doi.org/10.1016/j.cjca.2016.01.032

      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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