scholarly journals Statin Therapy in Very Old Patients: Lights and Shadows

2021 ◽  
Vol 8 ◽  
Author(s):  
Lidia Cobos-Palacios ◽  
Jaime Sanz-Cánovas ◽  
Mónica Muñoz-Ubeda ◽  
María Dolores Lopez-Carmona ◽  
Luis Miguel Perez-Belmonte ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cardiovascular Prevention ◽  
Vascular Events ◽  
Old Patients ◽  
Very Old ◽  
Aged People ◽  
Age Related ◽  
Very Old Patients ◽  
Statin Use

Atherosclerotic cardiovascular diseases (ASCVD) are the leading cause of death worldwide. High levels of total cholesterol—and of low-density lipoprotein cholesterol in particular—are one of the main risk factors associated with ASCVD. Statins are first-line treatment for hypercholesterolemia and have been proven to reduce major vascular events in adults with and without underlying ASCVD. Findings in the literature show that statins reduce coronary and cerebrovascular morbidity and mortality in middle-aged people, but their benefits in older adults are not as well-established, especially in primary prevention. Furthermore, many particularities must be considered regarding their use in old subjects, such as age-related changes in pharmacokinetics and pharmacodynamics, comorbidities, polypharmacy, and frailty, which decrease the safety and efficacy of statins in this population. Myopathy and a possible higher risk of falling along with cognitive decline are classic concerns for physicians when considering statin use in the very old. Additionally, some studies suggest that the relative risk for coronary events and cardiovascular mortality associated with high levels of cholesterol decreases after age 70, making the role of statins unclear. On the other hand, ASCVD are one of the most important causes of disability in old subjects, so cardiovascular prevention is of particular interest in this population in order to preserve functional status. This review aims to gather the current available evidence on the efficacy and safety of statin use in very old patients in both primary and secondary prevention.

Escherichia colibacteraemia in adults: age-related differences in clinical and bacteriological characteristics, and outcome

2014 ◽  
Vol 142 (12) ◽  
pp. 2672-2683 ◽  
Author(s):  
C. ROUBAUD BAUDRON ◽  
X. PANHARD ◽  
O. CLERMONT ◽  
F. MENTRÉ ◽  
B. FANTIN ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Death Rate ◽  
The Elderly ◽  
Age Group ◽  
Old Patients ◽  
Very Old ◽  
Comorbidity Score ◽  
Age Related ◽  
Very Old Patients

SUMMARYTo explore the specificities ofEscherichia colibacteraemia in the elderly, the demographic, clinical and bacteriological characteristics and in-hospital mortality rate of ‘young’ (18–64 years,n = 395), ‘old’ (65–79 years,n = 372) and ‘very old’ (⩾80 years,n = 284) adult patients of the multicentre COLIBAFI cohort study were compared. Clinical and bacteriological risk factors for death were jointly identified by logistic regression and multivariate analysis within each group. ‘Young’ and ‘old’ patients had more comorbidities than ‘very old’ patients (comorbidity score: 1·5 ± 1·3 and 1·6 ± 1·2vs. 1·2 ± 1·2, respectively;P < 0·001), and were more frequently nosocomially infected (22·3% and 23·8%vs. 8·8%, respectively;P < 0·001). ‘Old’ patients had the poorest prognosis (death rate: 16·4%vs.10·4% for ‘young’ and 12·0% for ‘very old’ patients, respectively;P = 0·039). Risk factors for death were age group-specific, suggesting a host–pathogen relationship evolving with age.

scholarly journals Effects of Inappropriate Empirical Antimicrobial Therapy on the Outcomes of Patients with Community-Onset Bacteremia: Age Matters

2021 ◽  
Author(s):  
Chih-Hao Lin ◽  
Po-Lin Chen ◽  
Ching-Yu Ho ◽  
Chung-Hsun Lee ◽  
Chih-Chia Hsieh ◽  
...  
Keyword(s):  
Average Increase ◽  
Middle Aged ◽  
Multicenter Cohort Study ◽  
Aged Patients ◽  
Old Patients ◽  
Very Old ◽  
Age Related ◽  
Crude Mortality ◽  
Community Onset ◽  
Very Old Patients

Abstract Background: Studies have reported the effects of delayed administration of appropriate empirical antimicrobial (AEA) on the prognosis of patients with bloodstream infections; however, whether there is an age-related difference in these effects remains debated. Methods: In this 4-year multicenter cohort study, patients with community-onset bacteremia were retrospectively included and categorized into “middle aged” (45–64 years), “old” (65–74 years), and “very old” (≥75 years) groups. To determine the timing of AEA administration for each patient, all causative microorganisms were prospectively obtained. For each age group, the effects of delayed AEA administration on 30-day mortality were investigated after adjustment for the independent predictors of 30-day mortality determined using a logistic regression model.Results: Significant differences were observed in the distribution of comorbidity types, comorbidity severity, bacteremia sources, bacteremia severity, and causative microorganisms among 968 (33.2%) middle-aged, 683 (23.4%) old, and 1,265 (43.4%) very old patients. Although significant effects (adjusted odds ratio [AOR], 1.002; P = 0.07) of delayed AEA administration on prognosis were not observed in middle-aged patients, each hour of AEA delay resulted in an average increase in the 30-day crude mortality of 0.036% (AOR, 1.0036; P < 0.001) and 0.38% (AOR, 1.0038; P < 0.001) in old and very old patients, respectively. Practically in critically ill patients, each hour of delayed AEA administration resulted in an average increase of 0.03% (AOR, 1.003; P = 0.04), 0.4% (AOR, 1.004; P < 0.001), and 0.5% (AOR, 1.005; P = 0.001) in 30-day crude mortality in middle-aged, old, and very old patients, respectively. Conclusions: Regardless of bacteremia severity, the adverse effects of delayed AEA administration on the survival of patients with community-onset bacteremia increased with patients’ age. To achieve favorable outcomes, rapid AEA administration is recommended in older patients.

scholarly journals Psycho-Social Factors in Patients with Cardiovascular Disease Attending a Family-Centred Prevention and Rehabilitation Programme: EUROACTION Model in Spain

Life ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 89
Author(s):  
Cristina Buigues ◽  
Ana Queralt ◽  
Jose Antonio De Velasco ◽  
Antonio Salvador-Sanz ◽  
Catriona Jennings ◽  
...  
Keyword(s):  
Social Factors ◽  
Illness Perceptions ◽  
Vegetable Consumption ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cardiovascular Prevention ◽  
Anxiety And Depression ◽  
Coronary Patients ◽  
Low Levels ◽  
One Year

Background: Coronary heart disease (CHD) persists as the leading cause of death worldwide. Cardiovascular prevention and rehabilitation (CVPR) has an interdisciplinary focus, and includes not only in physiological components, but it also addresses psycho-social factors. Methods: The study analysed the Spanish psycho-social data collected during the EUROACTION study. In Spain, two hospitals were randomised in the Valencia community. Coronary patients were prospectively and consecutively identified in both hospitals. The intervention hospital carried out a 16-week CVPR programme, which aimed to assess illness perceptions and establish healthy behaviours in patients and their partners. Results: Illness perceptions were significantly and inversely associated with anxiety and depression. Low levels of anxiety were associated with better self-management of total cholesterol (p = 0.004) and low-density lipoprotein-cholesterol (p = 0.004). There was concordance at one year among patients and partners who participated in the programme related to anxiety (p < 0.001), fruit consumption (p < 0.001), and vegetable consumption (p < 0.001). Conclusions: The EUROACTION study emphasised the importance of assessing psycho-social factors in a CVPR programme and the inclusion of family as support in patients’ changes in behaviour.

Sign in / Sign up

Export Citation Format

Share Document