Статья
Липидснижающая терапия для первичной профилактики у пациентов 75 лет и старше. Консенсус экспертов Российской ассоциации геронтологов и гериатров, Национального общества по изучению атеросклероза, Российского кардиологического общества, Ассоциации клинических фармакологов
Завершившиеся рандомизированные клинические исследования не обладали достаточной статистической мощностью для демонстрации отчетливой эффективности липидснижающей терапии в целях первичной профилактики у пациентов 75 лет и старше, не оценивали влияние липидснижающей терапии на развитие и течение ключевых гериатрических синдромов. Возрастные изменения скелетной мускулатуры, когнитивное снижение, старческая астения, коморбидность, полипрагмазия, потенциальные изменения фармакокинетики и фармакодинамики лекарственных средств, снижение функции почек могут неблагоприятно влиять на отношение пользы и вреда статинов у пациентов старшего возраста. Принципиальные вопросы для проведения липидснижающей терапии с целью первичной профилактики у пациентов 75 лет и старше: 1. Сохраняется ли связь между повышением уровня холестерина (ХС) липопротеидов низкой плотности (ЛНП) и смертностью; 2. Сохраняется ли польза снижения уровня ХС ЛНП; 3. Безопасна ли липидснижающая терапия; 4. Какие шкалы для стратификации риска и определения показаний к липидснижающей терапии должны использоваться?
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