Elderly may be undertreated for cardiac disease

By Piriya Mahendra

Not enough elderly people are being prescribed statins, argue researchers in the BMJ.

This finding highlights the need for "a stronger evidence base and clearer guidelines for people aged over 75," they write.

Richard McManus (University of Oxford, UK) and team also found that women are not undertreated for the primary prevention of cardiovascular disease (CVD), contrary to previous reports of undertreatment for secondary prevention.

Their study showed that the proportion of people without a history of CVD at baseline who received antihypertensive drugs increased with age. Indeed, of individuals aged 40‑44 years, 5% received antihypertensive drugs compared with 57% of those aged 85 years or over.

The proportion of individuals taking statins also increased with age, at 3% of those aged 40‑44 years versus 29% of those aged 70‑74 years.

However, in people aged 75 years and over, the chance of being prescribed a statin (compared with those aged 40‑44 years) decreased with every 5-year increment in age, at an odds ratio of 12.9 for patients aged 75‑79 years compared with 5.7 for those aged 85 years and older.

Of note, there were no significant differences in prescription trends by gender. "This is surprising given that at any age men are at greater risk of a CVD event than women," remark the authors.

"There is a striking contrast between use of statins and use of antihypertensive drugs in older people, which does point to possible underuse of statins," they add.

McManus and team emphasize that the number of people aged 80 years and over is projected to increase rapidly, and that greater use of antihypertensive drugs could help reduce disability and prolong health life expectancy in this population.

The cross-sectional analysis included 41,250 records of patients aged 40 years or over who were registered at a general practice in the West Midlands, UK.

Overall, 36,679 (89%) patients did not have a history of CVD and were therefore considered appropriate for primary preventive treatment.

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