New Guidelines Offer Clarity on Cholesterol Management for Adults Over 75
October 26, 2023
The National Lipid Association (NLA) and the American Geriatrics Society (AGS) have jointly released crucial guidance on managing high cholesterol in older adults. The statement addresses the complexities of treatment decisions for those over 75 without prior heart disease, emphasizing personalized, evidence-based care.
Navigating Cholesterol Treatment in an Aging Population
As the U.S. population ages, a growing number of individuals over 75 are living without a history of atherosclerotic cardiovascular disease (ASCVD). However, deciding whether to start or continue cholesterol-lowering medication in this demographic is fraught with challenges. Limited clinical trial data for this age group, the presence of other health conditions (comorbidities), the risk of drug interactions (polypharmacy), and varying patient preferences all contribute to the complexity.
Recognizing this challenge, the National Lipid Association (NLA) and the American Geriatrics Society (AGS) have collaborated to release a Joint Scientific Statement. Published in both the Journal of the American Geriatrics Society and the Journal of Clinical Lipidology, this statement offers evidence-based recommendations to guide clinicians in making informed decisions about cholesterol management in older adults.
Key Considerations for Personalized Treatment
The Joint Scientific Statement emphasizes the need for personalized treatment plans that consider the unique circumstances of each patient. This includes carefully weighing the potential benefits of preventing ASCVD against the realities of aging, such as frailty, medication burden, and end-of-life considerations.
“Older persons have many competing medical and social needs, so treating high cholesterol in those without cardiovascular disease may not always be straightforward for clinicians and patients. We hope to help provide as much clarity as possible,” said Vera Bittner, MD, MSPH, MNLA, co-chair of the scientific statement.
The statement reviews existing research on lipid-lowering therapies in older individuals without established ASCVD. It provides practical recommendations to support clinical decision-making in this specific population.
This guidance is particularly relevant in the U.S., where heart disease remains a leading cause of death. According to the Centers for Disease Control and Prevention (CDC), about 1 in every 5 deaths in the United States is caused by heart disease.
Managing cholesterol levels effectively can substantially reduce this risk, but it’s crucial to tailor treatment to each individual’s needs, especially in older adults.
AGS Alignment for Optimal Geriatric Care
The American Geriatrics Society (AGS) brings its expertise in geriatric care to this collaborative effort,ensuring that the guidelines are sensitive to the needs of older adults.
“The AGS is excited to have aligned our efforts with NLA to ensure that lipid management for adults over 75 years of age is personalized, evidence-based, and mindful of the diverse needs of our aging population,” added Sunny Linnebur, PharmD, co-chair of the statement.
This collaboration is vital as older adults frequently enough have multiple health conditions and take several medications concurrently, increasing the risk of adverse drug interactions. The guidelines emphasize the importance of considering these factors when making treatment decisions.
practical Implications for U.S. Healthcare
The Joint scientific Statement has several practical implications for healthcare providers in the U.S.:
- Improved Decision-Making: The statement provides a framework for clinicians to make more informed decisions about cholesterol management in older adults, considering their individual risk factors, comorbidities, and preferences.
- personalized Treatment Plans: By emphasizing personalized care, the guidelines encourage clinicians to develop treatment plans that are tailored to each patient’s specific needs and goals.
- Reduced Polypharmacy: The statement highlights the importance of minimizing medication burden in older adults, which can help reduce the risk of adverse drug interactions and improve adherence to treatment.
- Enhanced Patient Engagement: By involving patients in the decision-making process and considering their preferences,the guidelines promote shared decision-making and empower older adults to take control of their health.
Such as, a geriatrician in a rural clinic in Iowa might use these guidelines to help an 80-year-old patient with high cholesterol decide whether to start a statin medication, taking into account her frailty, existing medications, and personal preferences. Similarly, a cardiologist in a large urban hospital coudl use the statement to guide treatment decisions for a 78-year-old patient with multiple comorbidities.
| Consideration | implication for U.S. Healthcare |
|---|---|
| Limited Clinical Trial Data | Emphasizes the need for real-world evidence and personalized approaches. |
| comorbidities | Requires careful consideration of drug interactions and potential side effects. |
| Polypharmacy | highlights the importance of medication reconciliation and deprescribing. |
| Patient Preferences | Promotes shared decision-making and patient-centered care. |
what are the primary challenges in managing high cholesterol, or hyperlipidemia, in individuals over 75, especially those without a history of heart disease?
Interview: Navigating New Cholesterol Guidelines for Seniors with Dr. Evelyn Reed
October 27, 2023
Introduction
Archyde News is pleased to present an exclusive interview with Dr. Evelyn Reed, a leading geriatric cardiologist and professor at the University of California, specializing in lipid management in older adults. Dr. Reed is also a contributor to the National Lipid Association (NLA) and the American Geriatrics Society (AGS) Joint Scientific Statement on cholesterol management for adults over 75. Welcome, dr. Reed.
Meeting the Challenges of Cholesterol Management
Archyde: Dr. Reed,the new guidelines from the NLA and AGS offer much-needed clarity. Could you summarise the primary challenges in managing high cholesterol, or hyperlipidemia, in individuals over 75, particularly those without a history of heart disease?
Dr. Reed: Certainly. The main challenges revolve around the limited data from clinical trials specifically focusing on this age group. We contend with comorbidities, the patient’s overall health and the impact of other existing diseases, polypharmacy – the use of multiple medications concurrently, and, importantly, individual patient preferences and quality of life considerations. Moreover,navigating if we should start or continue cholesterol-lowering medications for this specific population can be complex.
Personalized Treatment Approaches
Archyde: The statement emphasizes personalized treatment plans.How do these plans differ from approaches used with younger patients, and what factors are most critical in tailoring treatment?
Dr. Reed: The emphasis is on individualization. For patients over 75, we must weigh the potential benefits of preventing future cardiovascular events against the realities of aging. Factors like frailty, medication burden, cognitive function, and the patient’s personal goals and values regarding thier healthcare are crucial. We need to have a discussion with the patient to tailor the best fit for them.
Reducing the Risk of Medication Interactions
Archyde: Polypharmacy is a major concern. How do these guidelines address the risk of adverse drug interactions, and are there specific recommendations for managing it?
Dr. Reed: The guidelines highlight medication reconciliation – carefully reviewing all medications a patient is taking – as critical. This includes identifying potentially unnecessary drugs and deprescribing when appropriate. we emphasize considering the entire medication regimen and minimizing the number of drugs to the extent possible while providing effective cholesterol management. This is extremely important becuase this will improve the outcome and ensure patient compliance.
The role of Patient Preferences
Archyde: The importance for patient involvement is very relevant in these guidelines. can you elucidate the importance of patient preferences in the decision-making process for cholesterol management?
Dr. Reed: Absolutely. Shared decision-making is key. we must understand the patient’s values, their functional status, and their goals for their health. If a patient is frail with a limited life expectancy, the focus might be on quality of life rather than aggressive cholesterol reduction. Involving patients ensures they are active partners in their health journey.
Practical Implications and Advice
Archyde: Considering the practical implications, what specific advice would you offer to a family doctor or a geriatrician reading these new guidelines?
Dr. Reed: Focus on the individual. Assess frailty,cognitive function,and the overall health. Discuss the potential benefits and risks of cholesterol-lowering medication in this specific context, taking into account other existing medications and the patient’s preferences. Always prioritize a patient-centered approach.
Future Directions and Reader Engagement
Archyde: Looking ahead,what are the biggest research gaps or areas where future studies are most needed? And,for our readers,what insights or concerns do you believe are most important for them to discuss with their doctors?
Dr. Reed: More research is needed, specifically randomized clinical trials to guide decisions. For readers, I would urge you to have open discussions with yoru healthcare providers; ask about the benefits and risks specific to you, considering your overall health and make a plan that is beneficial for both you and your doctor.
Conclusion
Archyde: Dr. Reed, thank you for sharing your expertise with us. This is a comprehensive, critically important viewpoint. We appreciate your time and insights.
Dr. Reed: My pleasure. thank you for having me.
