Prise en charge des dyslipidémies chez les personnes âgées de 75 ans et plus. Évaluation de la prescription des statines et de l'exploration des anomalies lipidiques chez la personne âgée de 75 ans et plus dans un service de Médecine Interne, Gériatrie et Thérapeutique : comparaison des pratiques aux recommandations françaises

Abstract : Introduction: Management of dyslipidaemia in the elderly is debated, due to questions about the real statin’s benefit to mortality and to cardiovascular events in primary or secondary prevention, and about their tolerance in the context of polypathology and polymedication. In order to evaluate factors influencing statin’s prescription, we compared characteristics of patients aged 75 years and over, treated by statin or not, and with or without a lipid profile. Then we analysed motives for statin’s initiation or discontinuation, considering HAS recommendations. Patients and methods: We present a descriptive, retrospective study of 197 patients drawn at random among patients hospitalized between June 2016 and June 2017 in the department of Pr VILLANI. Clinical, biological and therapeutical data were collected from computerized medical charts. Results: Patients were aged in average 85 years. At admission, 48.2% of them were in secondary prevention, 39.1% were treated by statin and blood lipid was measured for 46.7% patients. Patients treated with statin were significantly younger, more polymedicated, more frequently in secondary prevention and less institutionalized than patients without statin. Patients with a lipid profile were significantly younger, more often with dyslipidaemia and with a statin treatment, less dependant, with less cognitive impairment, and were more often hospitalized for a cardio-vascular event than patients without lipid profile. For the 77 patients treated with statin at admission, the statin was stopped during the hospitalization in 72.7% of cases. Advanced age and normal lipid profile were the 2 main reasons for discontinuation. Among the 120 patients not treated, a statin was started for 5 of them, but 47 others had also a theorical indication. Lastly, age was the only factor associated with statin’s prescription for patients with an indication. Conclusion: In our study, as in the literature, age was the main limiting factor to prescribe statins. Geriatric assessment may be needed to appreciate fragility and limited life expectancy in the elderly. A better evaluation of the benefit-risk balance is indispensable. A specific clinical trial would permitt to assess the real benefit of statins in the elderly.
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Mathilde de Francesco. Prise en charge des dyslipidémies chez les personnes âgées de 75 ans et plus. Évaluation de la prescription des statines et de l'exploration des anomalies lipidiques chez la personne âgée de 75 ans et plus dans un service de Médecine Interne, Gériatrie et Thérapeutique : comparaison des pratiques aux recommandations françaises. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01949654⟩

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