Dự phòng tim mạch tiên phát ở người cao tuổi vai trò của aspirin và statin

15th Vietnam National Congress of Cardiology Hanoi, October 2016 PRIMARY PREVENTION OF CVD IN THE ELDERLY – the role of aspirin and statins Professor Christopher Reid, Co-Director CCRE Therapeutics School of Public Health & Preventive Medicine, Monash University Director, Curtin Centre of Clinical Research & Education School of Public Health, Curtin University Faculty Disclosures • No Disclosures CM Reid has received research support from Astra Zeneca, AMRAD, Bayer, BMS, Boehringer-Ingelheim, Sanofi Aventis, Servier, National Heart Foundation, National Health and Medical Research Council of Australia (Research Fellowship, Project and Program grants), and the US National Institutes of Health NIL related to this presentation Healthy Ageing “Based on population projections by the Australian Bureau of Statistics, there will be 9.6 million people aged 65 and over and 1.9 million people aged 85 and over by 2064” AIHW, 2016 % 65 and over Healthy Ageing • 1840 – Longest life held by Swedish women, average ~ 45 years old • At present, longest life held by Japanese women, average ~ 85 years old • 50% of babies born today will live to 107 y.o in Japan, and 104 y.o In Australia Healthy Ageing PREVENT OR DELAY THE ONSET OF CHRONIC CONDITIONS MAINTAIN INDEPENDANCE IMPROVED QUALITY OF LIFE IMPROVED EMOTIONAL WELL-BEING MOBILITY – FEWER FALLS AND FRACTURES Primary Prevention in the Elderly  Need to consider high levels of co-morbidities  Very few elderly in clinical trials (often excluded)  Treatment Recommendations often not based on trial evidence buy applied to elderly  In Primary Prevention it is critical to ensure that the benefits outweigh the risks “Make a habit of two things: to help; or at least to no harm” Hippocrates, ~400BC The role of Aspirin in the Elderly BENEFIT Clinical COX-1 & COX-2 NSAID Anti-thrombotic, anti-platelet Anti-inflammatory RISK Bleeding Public Health   Inexpensive, widely available High compliance  Haemorrhagic stroke GI bleeds, ulcers Increases with age Aspirin reduces the risk of MI in men and stroke in women Odds ratio Sex-specific meta-analysis of 51,342 women and 44,114 men randomized to aspirin (doses ranging between 100 mg every other day to 500 mg daily) vs placebo for 3.7-10 years * p