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Overenthusiastic stroke risk factor modification in the over-80s: Are we being disingenuous to ourselves, and to our oldest patients?
  1. Kit Byatt
  1. Department of Geriatric Medicine, The County Hospital, Union Walk, Hereford, UK
  1. Correspondence to: Dr Kit Byatt
    Department of Geriatric Medicine, The County Hospital, Union Walk, Hereford, HR1 2ER, UK; christopher.byatt{at}wvt.nhs.uk

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Introduction

Statins and antihypertensives were the most prescribed UK cardiovascular drugs in 2006.1 Many older patients (75% in one US study2) are on statins for primary prevention. I challenge this orthodoxy.

Epidemiology

Although stroke incidence increases exponentially with age from about 40, Framingham data confirm that the attributable risk from hypertension falls after 60, from a relative risk of 3.5 then, to statistically indistinguishable from 1 in the 80s.3 In a study of over 4000 ambulatory hypertensive patients over the age of 80 years, mortality was higher in the 5-year follow-up period in those with lower systolic and diastolic blood pressure (BP).4 Epidemiological evidence shows little effect of cholesterol on stroke risk.5 Data from 61 prospective observational studies yielded nearly 12 million person-years at risk between the ages of 40 and 89 years. The risk for ischaemic heart disease death, for any given level of cholesterol, fell with age and in participants over 70 years (and particularly for those with systolic BP over about 145 mm Hg) total cholesterol was negatively related …

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