Lipid-Lowering Therapy With Statins in High-Risk Elderly Patients

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Abstract
Available evidence has demonstrated that the impact of cardiovascular evidence-based therapies is predominantly dependent on patients' baseline risk of future adverse cardiovascular events.1 If physicians are appropriately attuned to the risk profiles of their patients, one might reasonably assume that patients who are at highest baseline risk should be treated most aggressively. Yet, for many cardiovascular therapies, this is not the case.2-6 For example, studies have consistently demonstrated an inverse relationship between treatment propensity and age.2,7 Moreover, patients with multiple chronic conditions are less likely to receive evidence-based therapies than healthier patients with lower illness severity,8 an observation that may relate to high baseline risk and/or concerns about treatment complications. Nonetheless, the extent to which the discordant relationship between baseline risk and treatment propensity is a phenomenon driven by age alone, arguably the most important determinant of baseline risk in the population, is unknown. Furthermore, the extent to which the treatment-risk paradox applies only to extremes of illness severity or, conversely, applies incrementally throughout the entire spectrum of risk is also unclear.