Benefits and limitations of statin use in primary cardiovascular prevention : recent advances

The status of low‑density lipoprotein (LDL) cholesterol is strong as an essential cause of atherosclerotic vascular disease (ASCVD) and primary target of lipid lowering. Drugs affecting primarily LDL choles‑ terol through an increase of LDL receptor expression are the backbone of current therapy, and generic statins are generally safe, effective, and inexpensive drugs serving this purpose. Statins are indicated for practically all patients in secondary prevention, whereas treatment in primary prevention (healthy individuals) is based on a calculated 10‑year risk of ASCVD. At “borderline” (from 5% to “intermediate” (from 7.5% to for accurate assessment of the individual risk. The calculation of a lifetime risk instead of the 10‑year risk can be especially useful in younger people. More information about the benefits and risks of statins in primary prevention in older people (>70 years of age) will be provided by ongoing randomized and controlled trials (STAREE and PREVENTABLE). In this narrative review, I shall present recent advances in the use of statins in younger and older healthy people, and discuss their benefits and potential risks. I also raise a question whether with the current evidence base, most people in affluent societies would benefit from taking statins.Peer reviewe

Role of Statin Therapy in Primary Prevention of Cardiovascular Disease in Elderly Patients

Purpose of ReviewHypercholesterolemia and statin treatment are nowadays common among people older than 75years, but clinical heterogeneity in this increasing age group is wide, and treatment decisions may differ from those in younger patients. Aim is to discuss the presentation, modifying factors, and treatment decisions of hypercholesterolemia (usually with statins) in older persons and focusing on primary prevention.Recent FindingsThere are no randomized controlled trials in persons older than 80years at baseline. Randomized controlled trial findings in younger patients and 75+ subgroups and in observational studies support treatment in secondary prevention of atherosclerotic cardiovascular disease (ASCVD), but trial evidence in primary prevention is less clear. Available data do not imply specific harms in older patients, and, therefore, also, judicious primary prevention is possible. However, persons older than 75years are biologically a very heterogeneous group with frequent frailty, comorbid conditions, and multiple concomitant drugs. All these, as well as personal preferences, must be taken into account in treatment decisions.SummaryStatin treatment is only one way to prevent ASCVD in older people. Treatment of hypercholesterolemia should be started far before 75-80years, and there is no need to discontinue statin treatment due to chronological age alone. After 75years, treatment should be started in patients with ASCVD and judiciously in primary prevention. Like all prevention, statin treatment should be discontinued when palliative treatment is started. Ongoing and planned trials in 70+ individuals will give more information about primary prevention in older persons.Peer reviewe

Terveet elämäntavat - terveet aivot

Teema: Terveet aivot 100 vuotta. English summaryPeer reviewe

Sauna bathing, health, and quality of life among octogenarian men: the Helsinki Businessmen Study

Sauna-type bathing has increased worldwide, and it has been related to both harmful and beneficial effects. There are few studies of bathing in sauna in very old age. The series consists of 524 mostly home-living survivors of the Helsinki Businessmen Study (HBS, mean age 86 years, range 80-95), who in 2015 responded to a questionnaire survey about lifestyle (including sauna bathing), prevalent diseases, and health-related quality of life (HRQoL, RAND-36). Of the men 57.6% (n = 302) reported all-year round and 17.6% (n = 92) part-year sauna bathing. Sauna was currently used mostly once a week, but 10% bathed more than twice a week. Median time in the hot room was 15 min at 80 A degrees C. Among 45.7% of the men, the habit had decreased with ageing, and 130 (24.8%) did not attend sauna. However, 92.2% of the latter had discontinued an earlier habit, respective proportions 20.7% and 75.0% among all-year and part-year users. Overall, reasons for decreased sauna bathing were nonspecific or related to mobility problems or diverse health reasons (n = 63). The most frequent motivations for sauna were relaxation and hygienic reasons. Of the RAND-36 domains physical function, vitality, social functioning, and general health were significantly better among sauna users than non-users. These differences partly remained after adjusting for prevalent diseases and mobility-disability. Regular sauna bathing was common among octogenarian men and was associated with better HRQoL. However, reverse causality must be taken into account in this cross-sectional study. The bathing habit seemed to be prudent and had decreased in almost half of the cohort.Peer reviewe

Definitions of successful ageing: a brief review of a multidimensional concept

Successful ageing has become an important concept to describe the quality of ageing. It is a multidimensional concept, and the main focus is how to expand functional years in a later life span. The concept has developed from a biomedical approach to a wider understanding of social and psychological adaptation processes in later life. However, a standard definition of successful ageing remains unclear and various operational definitions of concept have been used in various studies. In this review we will describe some definitions and operational indicators of successful ageing with a multidimensional approach.Peer reviewe

Clinical trials in older people

Randomised controlled trials (RCTs) usually provide the best evidence for treatments and management. Historically, older people have often been excluded from clinical medication trials due to age, multimorbidity and disabilities. The situation is improving, but still the external validity of many trials may be questioned. Individuals participating in trials are generally less complex than many patients seen in geriatric clinics. Recruitment and retention of older participants are particular challenges in clinical trials. Multiple channels are needed for successful recruitment, and especially individuals experiencing frailty, multimorbidity and disabilities require support to participate. Cognitive decline is common, and often proxies are needed to sign informed consent forms. Older people may fall ill or become tired during the trial, and therefore, special support and empathic study personnel are necessary for the successful retention of participants. Besides the risk of participants dropping out, several other pitfalls may result in underestimating or overestimating the intervention effects. In nonpharmacological trials, imperfect blinding is often unavoidable. Interventions must be designed intensively and be long enough to reveal differences between the intervention and control groups, as control participants must still receive the best normal care available. Outcome measures should be relevant to older people, sensitive to change and targeted to the specific population in the trial. Missing values in measurements are common and should be accounted for when designing the trial. Despite the obstacles, RCTs in geriatrics must be promoted. Reliable evidence is needed for the successful treatment, management and care of older people.Non peer reviewe