The value of primary preventative therapies for cardiovascular disease (CVD) in older adults (age ≥75 years) is less certain than in younger patients. There is a lack of quality evidence in older adults due to underenrolment in pivotal trials. While aspirin is no longer recommended for routine use in primary prevention of CVD in older adults, statins may be efficacious. However, it is unclear which patient subgroups may benefit most, and guidelines differ between expert panels. Three relevant geriatric conditions (cognitive impairment, functional impairment and polypharmacy) may influence therapeutic decision making; for example, baseline frailty may affect statin efficacy, and some have advocated for deprescription in this scenario. Evidence regarding statins and incident functional decline are mixed, and vigilance for adverse effects is important, especially in the setting of polypharmacy. However, aspirin has not been shown to affect incident cognitive or functional decline, and its lack of efficacy extends to patients with baseline cognitive impairment or frailty. Ultimately, the utility of primary preventative therapies for CVD in older adults depends on potential lifetime benefit. Rather than basing treatment decisions on absolute risk alone, consideration of comorbidities, polypharmacy and life expectancy should play a significant role in decision making. Coronary calcium score and new tools for risk stratification validated in older adults that account for the competing risk of death may aid in evaluating potential benefits. Given the complexity of therapeutic decisions in this context, shared decision making provides an important framework.

中文翻译：

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阿司匹林和他汀类药物治疗老年人心血管疾病的一级预防

老年人（≥75 岁）心血管疾病 (CVD) 初级预防治疗的价值不如年轻患者确定。由于关键试验的注册不足，老年人缺乏质量证据。虽然不再推荐将阿司匹林常规用于老年人 CVD 的一级预防，但他汀类药物可能有效。然而，尚不清楚哪些患者亚组可能受益最多，并且专家小组之间的指南也有所不同。三种相关的老年病（认知障碍、功能障碍和多重用药）可能会影响治疗决策；例如，基线虚弱可能会影响他汀类药物的疗效，有些人主张在这种情况下取​​消处方。关于他汀类药物和事件功能衰退的证据好坏参半，并且对不良反应保持警惕很重要，尤其是在使用多种药物的情况下。然而，阿司匹林并未显示出会影响认知或功能下降，并且其缺乏疗效延伸到基线认知障碍或虚弱的患者。最终，老年人 CVD 初级预防疗法的效用取决于潜在的终生益处。与其仅根据绝对风险做出治疗决定，还应考虑合并症、多种药物和预期寿命，在决策中发挥重要作用。冠状动脉钙化评分和新的风险分层工具在老年人中得到验证，这些工具解释了死亡的竞争风险，可能有助于评估潜在的益处。鉴于在这种情况下治疗决策的复杂性，