Too many healthy people in their 80s and older are being treated with statins and hypertensives for stroke prevention, according to British commentary in Evidence-Based Medicine.
The epidemiology suggests that, by this stage, hypertension is not an attributable risk factor for stroke and hypercholesterolemia has little effect on stroke risk overall. The largest trials of antihypertensive therapy and statins in this age group show at best a marginal clinical reduction in stroke and very modest clinical reductions in other cardiovascular endpoints.
I wholeheartedly agree with the author that we overprescribe medications in elderly asymptomatic elders. I never start patients in their 80s on statins for primary prevention. If they have not had a cardiac event by that age, it is unlikely that they will during their life. Antihypertensives can cause severe orthostatic hypotension and I am very conservative with these agents.
I often see patients coming in with 15 to 20 different medications they are supposed to take. I honestly don't know how they keep the medicines straight. I tried to limit meds to three or four at most, and ideally at once a day dose.
While there are guidelines that aid in management, ultimately it is an individual decision between the physician and the patient, after weighing the risks and benefits of treatment as well as factoring in the patient's quality of life, other medical condition, risk for stroke and heart attack, and life expectancy.
Next month, I'll discuss how I've changed my own pill regimen and bucked the over-medication trend among seniors. Prescribed meds now? Only one. Supplements? Only three.