July 12, 2012 More patients aged 75 and over should be prescribed drugs to help lower their risk of cardiovascular disease, a study recently published on the British Medical Journal website.
The researchers argue that older people are being "largely ignored" by current guidance, yet as the population ages, greater use of these drugs could reduce disability and prolong healthy life expectancy.
Cardiovascular diseases such as stroke, heart attack and heart failure are the principal cause of death in the UK and around the world. Drugs that help to lower blood pressure (antihypertensives) and cholesterol levels (statins) are safe and effective, yet current guidelines for preventing cardiovascular disease focus only on people aged 40-74 years.
Previous studies focusing on patients with existing cardiovascular disease have also found that patients are less likely to receive preventative treatment the older they get, despite the fact that the risk of developing cardiovascular disease increases with age.
So a team of researchers from the University of Birmingham and the University of Oxford studied 36,679 patients aged 40 and over from 19 general practices in the West Midlands, to establish whether age and sex impact on prescriptions for antihypertensives and statins. None of the patients had a history of cardiovascular disease at the start of the study.
Results show that the likelihood of using antihypertensive medication increased with every five years but started to decline after the age of 85. Patients aged 75 and over had the highest use overall (56%) and women were 10% more likely to be taking antihypertensives than men.
The likelihood of using statin medication also increased with every five years but decreased with every five years after the age of 75, although 23% of all patients aged 75 and over were taking statins. Those aged 70-74 had the highest use. Women aged between 65-69 and 75-79 were 5% more likely to be issued a prescription than men whilst men under the age of 60 were more likely to be issued a prescription.
A 2008 study has shown that antihypertensive treatment in those over 80 can reduce the risk of cardiovascular disease. The evidence for statin treatment in the elderly is less clear because trials have not been conducted in this population, but the authors say that there is no evidence to suggest that prescribing statins in elderly patients causes any harm.
The authors conclude that the older population should not be ignored when prescribing drugs to prevent cardiovascular disease. They suggest that guidelines should be modified and future research should look at the use of statin therapy in people aged 80 or more and that treating those aged 75 and over with these drugs "could be an appropriate place to start."
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- J. P. Sheppard, S. Singh, K. Fletcher, R. J. McManus, J. Mant. Impact of age and sex on primary preventive treatment for cardiovascular disease in the West Midlands, UK: cross sectional study. BMJ, 2012; 345 (jul12 2): e4535 DOI: 10.1136/bmj.e4535
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