Statins: Benefits in over 65s? 2017 Release.

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Dr Gregory Curfman of Harvard Medical School and health care policy Says,”Statin therapy in older adults may be associated with an increased mortality rate” , “should be considered before prescribing or continuing statins for patients in this age category”.

People who have had an ischemic stroke often have fatty deposits inside their arteries called plaques. These plaques are made up mostly of cholesterol. Statins lower cholesterol, so they reduce the chances that plaques will form. They might also help shrink plaques and make them less likely to break open.

Examples of statins include atorvastatin (brand name: Lipitor), lovostatin (brand names: Mevacor, Altoprev), Pravstatin (brand name: Pravachol), rosuvastatin (Crestor), and simvastatin (Zocor).

 Adverse reactions occur less frequently with the statins than with most other classes of lipid lowering agents. Hepatic dysfunction has been a source of concern; however, the actual risk appears to be very small. Adverse muscle events remain important side effects.

There have been concerns that the more lipophilic statins (simvastatin, lovastatin, atorvastatin, and fluvastatin) may be associated with more adverse events than the more hydrophilic statins (pravastatin and rosuvastatin) ; however, fluvastatin (a lipophilic statin) appears to have a low rate of muscle side effects.

Patients with severe renal impairment, we treatment with atorvastatin or fluvastatin is suggestive. These medications do not require dose adjustment.

In patients with chronic liver disease who require a statin because of high cardiovascular risk, we suggest complete abstinence from alcohol and the use of pravastatin at a low dose .

Fewer pharmacokinetic drug interactions are likely to occur with pravastatin, fluvastatin, rosuvastatin, and pitavastatin because they are not metabolized through the CYP3A4  Pathway.

There are no clear data that the adverse event profile differs significantly among statins. However, pravastatin and fluvastatin appear less likely to cause muscle toxicity than other statins. (Cases of Myopathy)

We suggest not routinely monitoring serum creatine kinase (CK), but it is useful to obtain a baseline CK level for reference purposes prior to starting statin therapy. Patients treated with statins should be alerted to report the new onset of myalgias or weakness.

 

http://www.ephor.nl/media/1365/statines-effect-ontbreekt-bij-ouderen-jamainternal_han_2017_oi_170031.pdf

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