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Primary prevention of cardiovascular disease ‘ignored’ in the elderly

The cardiovascular risk factors of elderly people are being 'largely ignored' as guidelines recommend primary prevention for those aged 74 or younger, say researchers.

Their UK study - published today - showed 23% of patients aged 75 and older were prescribed statins in primary care despite clear risk factors for cardiovascular disease being recorded.

Researchers from the University of Birmingham and the University of Oxford studied the medical records of 36,679 patients aged 40 and over - who did not have a history of cardiovascular disease at the start of the study - from 19 general practices in the West Midlands.

Although the likelihood of using antihypertensive medication increased with every five years up to age 85, it declined after the age of 85. The use of statins increased with every five years but decreased with every five years after the age of 75.

They concluded although the risk of developing cardiovascular disease increases with age, thecurrent guidelines for preventing stroke, heart attack and heart failure focussed only on people aged 40-74 years.

NICE guidelines on lipid modification only recommend primary prevention in patients aged 40 to 74 years, and the NHS Healthcheck programme follows this advice.

Professor Richard McManus, professor of primary care research at the University of Oxford and a GP in Birmingham said: ‘This increasingly important cohort of older individuals has been largely ignored by current primary prevention programmes, which focus on people under the age of 75.'

‘As the population ages, both statins and antihypertensive drugs offer the prospect of further reducing mortality and cardiovascular disease events, but only if they are prescribed.'

‘Ultimately, evidence is needed to inform new guidelines that offer more precise recommendations on primary prevention for older people.'


BMJ 2012, online 13 July

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