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Benefício e risco da terapêutica com estatinas em prevenção secundária em idosos (75 ou mais anos) frágeis : revisão e protocolo de investigação
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Introdução: O impacto da dislipidemia no risco cardiovascular pode ser subestimado e a sua gestão levanta dúvidas na população acima dos 75 anos por ausência de evidência robusta, em particular em idosos frágeis. As recomendações atuais sugerem benefício na prevenção secundária no uso de estatinas, independentemente da idade. Contudo, doentes idosos frágeis apresentam um risco aumentado de desfechos adversos, permanecendo a incerteza sobre os benefícios e riscos da terapêutica com estatinas em prevenção secundária (de acidente vascular cerebral, enfarte do miocárdio, coronariopatia isquémica, morte por causas cardiovasculares e morte por todas as causas) em idosos (75 ou mais anos) frágeis.
Metodologia: Realizou-se uma revisão da literatura de estudos científicos no Pubmed com os termos cardiovascular diseases, mortality, frail elderly e statins.
Resultados: Obteve-se um conjunto de 24 artigos potencialmente relevantes, dos quais se incluíram um Estudo Coorte Prospetivo e uma Revisão Baseada na Evidência.
Discussão: A evidência demonstra que na prevenção secundária de doentes idosos frágeis de idade avançada, a eficácia do uso de estatinas é incerta. Da mesma forma, os efeitos adversos associados à terapêutica com estatinas nestes doentes também se encontram mal definidos. Na ausência de evidente melhoria clínica na qualidade de vida, recomenda-se que a norma deva ser a revisão cuidada da evidência antes da aplicação das guidelines atuais na abordagem de um doente idoso frágil (2B). Não há razão para a iniciação ou continuidade de terapêutica com estatinas em prevenção primária nos doentes idosos severamente frágeis pela fraca possibilidade desta terapêutica lhes conferir benefícios em termos de outcomes relevantes (2B). Provavelmente as estatinas não são necessárias para a prevenção secundária de doentes idosos severamente frágeis (2B). Apenas lhes deve ser prescrita medicação se conferir melhoria na qualidade de vida (2B).
Introduction: The impact of dyslipidemia on cardiovascular risk can be underestimated and its management may raise doubts in the population over 75 years of age due to the absence of robust evidence, particularly in frail elderly. Current recommendations suggest the use of statins to be benefitial in secondary prevention, regardless of age. However, frail elderly patients are at an increased risk of adverse outcomes, and uncertainty remains about the benefits and risks of statin therapy in secondary prevention (of stroke, myocardial infarction, ischemic coronary artery disease, cardiovascular diseases mortality and all-cause mortality) in frail elderly (75 years and older). Methods: A literature review of scientific studies was carried out at Pubmed with the terms cardiovascular diseases, mortality, frail elderly and statins. Results: A set of 24 potentially relevant articles were obtained from which a Cohort Study and an Evidence Based Review were included. Discussion: Evidence shows that in secondary prevention of frail very elderly patients, the effectiveness of statins is uncertain. Likewise, the adverse effects associated with statin therapy in these patients are also poorly defined. In the absence of evident clinical improvement in quality of life, it is recommended that the norm should be a careful review of the evidence before applying the current guidelines in the management of a frail elderly patient (2B). There is no reason for the initiation or continuation of therapy with statins in primary prevention in elderly patients who are severely fragile due to the low possibility of this therapy giving them benefits in terms of relevant outcomes (2B). Statins are probably not necessary for the secondary prevention of severely frail elderly patients (2B). Prescription should only be given if it confers improvement in quality of life (2B).
Introduction: The impact of dyslipidemia on cardiovascular risk can be underestimated and its management may raise doubts in the population over 75 years of age due to the absence of robust evidence, particularly in frail elderly. Current recommendations suggest the use of statins to be benefitial in secondary prevention, regardless of age. However, frail elderly patients are at an increased risk of adverse outcomes, and uncertainty remains about the benefits and risks of statin therapy in secondary prevention (of stroke, myocardial infarction, ischemic coronary artery disease, cardiovascular diseases mortality and all-cause mortality) in frail elderly (75 years and older). Methods: A literature review of scientific studies was carried out at Pubmed with the terms cardiovascular diseases, mortality, frail elderly and statins. Results: A set of 24 potentially relevant articles were obtained from which a Cohort Study and an Evidence Based Review were included. Discussion: Evidence shows that in secondary prevention of frail very elderly patients, the effectiveness of statins is uncertain. Likewise, the adverse effects associated with statin therapy in these patients are also poorly defined. In the absence of evident clinical improvement in quality of life, it is recommended that the norm should be a careful review of the evidence before applying the current guidelines in the management of a frail elderly patient (2B). There is no reason for the initiation or continuation of therapy with statins in primary prevention in elderly patients who are severely fragile due to the low possibility of this therapy giving them benefits in terms of relevant outcomes (2B). Statins are probably not necessary for the secondary prevention of severely frail elderly patients (2B). Prescription should only be given if it confers improvement in quality of life (2B).
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Doenças cardiovasculares Mortalidade Idoso frágil Estatinas