Statin Therapy and Cognition in Older People: What is the Evidence?

Whether to start, continue or discontinue statins in older people remains a clinical and ethical dilemma. While there is clinical trial evidence that statins reduce cardiovascular morbidity in older people, recently concerns have been raised about side effects in this population. Adverse effects of statins reported in older people include muscle-related symptoms, diabetes, impaired physical function and cognitive impairment. The cognitive effects of statins are not well understood and remain contentious. In younger and healthier people with baseline intact cognitive function, short-term data suggest no adverse effects of statins on cognition whereas long-term data support a beneficial role for statins in delaying dementia. Insufficient evidence is currently available to establish causality in relation to statins and cognitive function in older people specifically. The objective of this narrative review is to analyse the current evidence in relation to statin therapy and cognition, and discuss challenges in translating the current evidence to older people.

Unusual features of apical hypertrophic cardiomyopathy.

Apical hypertrophic cardiomyopathy (HC) is commonly regarded as a relatively benign condition of young to middle-aged Japanese men. Apical HC in a predominantly Caucasian population is not well characterized. The cardiovascular characteristics, morbidity, and mortality of a series of elderly, predominantly Caucasian subjects with apical HC are described. Thirty-two consecutive patients with apical HC (mean age 71 years, 15 men) were identified from a teaching hospital without a specialized HC clinic. Twenty-three subjects were Caucasian, 8 were Asian, and none Japanese. Twenty-two patients had coexistent hypertension. Six patients had documented late evolution of apical HC on electrocardiography and echocardiography up to 5 years after previous documented normal left ventricular morphology on echocardiography. The diagnosis of apical HC was initially missed in 7 patients because of inadequate image quality of the left ventricular apex and a lack of awareness of the condition. The correct diagnosis was assigned to all 7 patients after repeat echocardiography. Six of 13 patients who underwent coronary angiography had associated coronary artery fistulae. One patient required an implantable defibrillator for exertional syncope. Ten of the patients developed atrial fibrillation, 6 of whom had complicating thromboembolic events. Of the 6 deaths in the cohort, 2 followed atrial fibrillation-related hemiplegic strokes, and 2 followed progressive heart failure. In conclusion, apical HC in a teaching hospital without a specialized HC clinic and in a predominantly Caucasian population is a disease of the elderly. Documented late morphologic evolution is not uncommon, with a high incidence of coronary fistulae and morbid atrial fibrillation.

Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review.

Coronary heart disease (CHD) is a leading cause of death globally. Despite proven health benefits and international recommendations, attendance at cardiac rehabilitation programs is poor. Telehealth (phone, Internet, and videoconference communication between patient and health-care provider) has emerged as an innovative way of delivering health interventions. This review aimed to determine telehealth effectiveness in CHD management. Study design includes systematic review with meta-analysis. Randomized controlled trials evaluating telehealth interventions in patients with CHD were identified by searching multiple electronic databases, reference lists, relevant conference lists, gray literature, and key-word searching of the Internet. Studies were selected if they evaluated a telephone, videoconference, or web-based intervention, provided objective measurements of mortality, changes in multiple risk factor levels or quality of life. In total, 11 trials were identified (3145 patients). Telehealth interventions were associated with nonsignificant lower all-cause mortality than controls [relative risk=0.70, 95% confidence interval (CI)=0.45-1.1; P=0.12]. These interventions showed a significantly lower weighted mean difference (WMD) at medium long-term follow-up than controls for total cholesterol (WMD=0.37 mmol/l, 95% CI=0.19-0.56, P<0.001), systolic blood pressure (WMD=4.69 mmHg, 95% CI=2.91-6.47, P<0.001), and fewer smokers (relative risk = 0.84, 95% CI=0.65-0.98, P = 0.04). Significant favorable changes at follow-up were also found in high-density lipoprotien and low-density lipoprotein. In conclusion, telehealth interventions provide effective risk factor reduction and secondary prevention. Provision of telehealth models could help increase uptake of a formal secondary prevention by those who do not access cardiac rehabilitation and narrow the current evidence-practice gap.