Published Online
on December 28, 2006

A more recent version of this article appeared on February 1, 2007

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Submitted on August 24, 2006
Revised on September 13, 2006
Accepted on October 3, 2006

Is it Time for a Cardiovascular Primary Prevention Trial in the Elderly?

Jennifer G. Robinson MD, MPH^*; George Bakris MD; James Torner PhD; Neil J. Stone MD; and Robert Wallace MD

From the University of Iowa, Iowa City (J.G.R., J.T., R.W.); University of Chicago, Chicago, Ill (G.B.); and Northwestern University, Evanston, Ill (N.J.S.).

^* To whom correspondence should be addressed. E-mail: jennifer-g-robinson{at}uiowa.edu.

Background and Purpose--Statins have been shown conclusively to reduce the risk of cardiovascular events in subjects with clinical cardiovascular disease or diabetes aged 65 to 80 years of age. However, few data are available for primary prevention of cardiovascular disease in those aged 70 years.

Summary of Review--A moderate-dose statin was of little benefit in a population aged 70 to 82 years when given for 3 years in the setting of suboptimally treated blood pressure. More evidence supports the use of blood pressure-lowering medications, but few data are available regarding the appropriate blood pressure target and most effective agents in the elderly. Some evidence also suggests that the elderly could experience higher mortality with antihypertensive treatment. These findings, along with greater safety concerns and an increasing number of competing risks and medical conditions with advancing age, make it imperative to carefully evaluate the risk/benefit balance from treating hypercholesterolemia and hypertension in persons aged 70 years.

Conclusions--We propose a 5-year 2x2 factorial trial of primary prevention in the elderly that will (1) evaluate whether statin therapy will reduce the risk of cardiovascular events when added to the treatment of hypertension to achieve a blood pressure <140/90 mm Hg in most patients and (2) determine the most appropriate blood pressure regimen for the prevention of cardiovascular and renal events.

Key words: cardiovascular disease • elderly • hypertension • primary prevention • statins

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