Revisão Sistemática da eficácia das estatísticas da prevenção secundária em idosos
Revisão Sistemática da eficácia das estatísticas da prevenção secundária em idosos
Data
2017
Autores
Shoshima, André Yoshikane
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Embora diversos estudos tenham demonstrado a relação de altas concentrações séricas de colesterol e o aumento da incidência de doenças cardiovasculares (DCV), esta relação para os idosos parece ser inversa. As estatinas já comprovaram seus benefícios no tratamento das DCV em adultos. Esta relação está muita mais clara na prevenção secundária de DCV. Baseado nesse contexto, o objetivo deste trabalho foi avaliar a eficácia do uso de estatinas na prevenção secundária de eventos cardiovasculares em idosos. Realizou-se uma revisão sistemática da literatura nas bases de dados: Medline (via PubMed), Embase, Cochrane Library, Centre for Reviews and Dissemination (CRD), onde buscaram-se ensaios clínicos randomizados (ECR) que avaliassem a eficácia das estatinas em idosos cujos desfechos analisados fossem mortalidade (por todas as causas ou por DCV), infarto agudo do miocárdio fatal e não fatal, acidente vascular cerebral (AVC) ou revascularização. Dois técnicos identificaram de maneira independente artigos que atendessem os critérios de inclusão e exclusão. A qualidade das evidências foi verificada utilizando a ferramenta de avaliação de risco de viés da Cochrane. Seis ECR foram incluídos na revisão sistemática e as metanálises foram realizadas por desfecho. O resultado desta revisão sistemática demonstra que, em idosos com uma doença cardiovascular pré-existente, a estatina é capaz de reduzir morte por todas as causas apresentando um risco relativo de 0,78 (IC 95% 0,70-0,86) I2=0% (p=0,7912), morte por DCV RR=0,69 (IC 95% 0,60-0,80) I2=0% (p=0,5081), infarto agudo do miocárdio fatal e não fatal RR=0,72 (IC 95% 0,63-0,83) I2=0% (p=0,8489), infarto agudo do miocárdio não fatal RR=0,75 (IC 95% 0,64-0,87) I2=0% (p=0,7460), AVC RR=0,80 (IC 95% 0,66-0,96) I2=42,6% (p=0,1373) e revascularização RR=0,70 (IC 95% 0,60-0,81) I2=0% (p=0,5611). Embora as estatinas tenham demonstrado eficácia, as decisões de tratamento devem considerar a situação individual do paciente em relação à comorbidade, polifarmácia e a opinião do mesmo, visto que os idosos apresentam um risco maior de efeitos adversos a esta classe de medicamento.
Although several studies have demonstrated the relationship between high serum cholesterol levels and cardiovascular disease (CVD) incidence, this relationship for the elderly seems to be the opposite. Statins have already demonstrated their benefits in the treatment of CVD in adults. This correspondence is much clearer in secondary prevention of CVD. Based on this context, the objective of this study was to evaluate the efficacy of statins in the secondary prevention of cardiovascular events in the elderly. A systematic literature review was conducted in the databases: Medline (by PubMed), Embase, Cochrane Library, Center for Reviews and Dissemination (CRD), In which searched for randomized controlled trials (RCTs) that evaluated the efficacy of statins in the elderly whose outcomes were mortality (all causes or CVD), fatal and nonfatal myocardial infarction, stroke or revascularization. Two independently reviewers identified articles that met the inclusion and exclusion criteria. The quality of the evidence was verified using the Cochrane bias risk assessment tool. Six RCTs were included in the systematic review and meta-analysis was performed by outcome. The results of this systematic review show that in the elderly with a pre-existing cardiovascular disease the statin is able to reduce death from all causes, presenting a relative risk of 0.78 (95% CI 0,70-0,86) I2=0% (p=0,7912), death by CVD RR=0.69 (95% CI 0,60-0,80) I2=0% (p=0,5081), fatal and nonfatal acute myocardial infarction RR=0,72 (95% CI 0,63-0,83) I2=0% (p=0,8489), nonfatal myocardial infarction RR=0,75 (95% CI 0,64-0,87) I2=0% (p=0,7460), AVC RR=0.80 (95% CI 0,66-0,96) I2=42,6% (p=0,1363) and revascularization RR=0,70 (95% CI 0,60-0,81) I2=0% (p=0,5611). Despite statins have shown efficacy, treatment decisions should consider the patient's individual status regarding comorbidity, polypharmacy, and patient opinion, since the elderly have a higher risk of adverse effects by this drug’s class.
Although several studies have demonstrated the relationship between high serum cholesterol levels and cardiovascular disease (CVD) incidence, this relationship for the elderly seems to be the opposite. Statins have already demonstrated their benefits in the treatment of CVD in adults. This correspondence is much clearer in secondary prevention of CVD. Based on this context, the objective of this study was to evaluate the efficacy of statins in the secondary prevention of cardiovascular events in the elderly. A systematic literature review was conducted in the databases: Medline (by PubMed), Embase, Cochrane Library, Center for Reviews and Dissemination (CRD), In which searched for randomized controlled trials (RCTs) that evaluated the efficacy of statins in the elderly whose outcomes were mortality (all causes or CVD), fatal and nonfatal myocardial infarction, stroke or revascularization. Two independently reviewers identified articles that met the inclusion and exclusion criteria. The quality of the evidence was verified using the Cochrane bias risk assessment tool. Six RCTs were included in the systematic review and meta-analysis was performed by outcome. The results of this systematic review show that in the elderly with a pre-existing cardiovascular disease the statin is able to reduce death from all causes, presenting a relative risk of 0.78 (95% CI 0,70-0,86) I2=0% (p=0,7912), death by CVD RR=0.69 (95% CI 0,60-0,80) I2=0% (p=0,5081), fatal and nonfatal acute myocardial infarction RR=0,72 (95% CI 0,63-0,83) I2=0% (p=0,8489), nonfatal myocardial infarction RR=0,75 (95% CI 0,64-0,87) I2=0% (p=0,7460), AVC RR=0.80 (95% CI 0,66-0,96) I2=42,6% (p=0,1363) and revascularization RR=0,70 (95% CI 0,60-0,81) I2=0% (p=0,5611). Despite statins have shown efficacy, treatment decisions should consider the patient's individual status regarding comorbidity, polypharmacy, and patient opinion, since the elderly have a higher risk of adverse effects by this drug’s class.
Description
Palavras-chave
Meta-Analysis, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cholesterol, Cardiovascular Diseases, Aged, Metanálise, Colesterol, Doenças Cardiovasculares, Inibidores da Hidroximetilglutaril Coenzima A Redutase, Idosos, Inibidores de Hidroximetilglutaril-CoA Redutases
Citação
Shoshima AY. Revisão Sistemática da eficácia das estatísticas da prevenção secundária em idosos. Rio de Janeiro. Dissertação [Mestrado Profissional em Avaliação de tecnologias em Saúde] - Instituto Nacional de Cardiologia; 2017.