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Statinetherapie bij 80-plussers: starten of staken?

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Huisarts en wetenschap Aims and scope

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Koning AS. Statinetherapie bij 80-plussers: starten of staken? Huisarts Wet 2016;59(2):50-3.

Onderzoek heeft duidelijk aangetoond dat statines het risico op hart- en vaatziekten (HVZ) verminderen. In die onderzoeken zijn echter zelden 80-plussers geïncludeerd.

In deze beschouwing worden de voors en tegens van statinegebruik door 80-plussers tegen elkaar afgewogen. Statines geven een risico op bijwerkingen, zoals leverfunctiestoornissen, een licht verhoogde kans op diabetes mellitus en, vooral, soms ernstige spierklachten. Er is weinig bewijs dat statines zinvol zijn voor 80-plussers zonder HVZ in de voorgeschiedenis. Zulke primaire preventie leidt waarschijnlijk alleen tot een verschuiving van de sterfte aan HVZ naar sterfte aan kanker. Uitzondering zijn 80-plussers met diabetes: bij hen reduceren statines zowel de cardiovasculaire als de totale sterfte. Ook bij 80-plussers met HVZ in de voorgeschiedenis zijn statines bewezen effectief. Bij deze twee categorieën patiënten kan men de NHG-Standaard Cardiovasculair risicomanagement onverkort volgen.

Abstract

Koning AS. Statins for the over 80s: start or stop? Huisarts Wet 2016;59(2):50-3.

Clinical trials have shown statins to reduce the risk of cardiovascular disease (CVD); however, few such studies included individuals aged 80 years or older. This review discusses the pros and cons of statin therapy in these patients. Statins increase the risk of adverse events such as liver disorders and severe muscle pain and slightly increase the risk of diabetes. There is a lack of solid evidence that statins are useful in people aged 80 and older who do not have a history of CVD. Indeed, primary prevention with statins may only change the cause of death from CVD to cancer, with the exception of individuals with diabetes, in whom statins reduce the risk of CVD and all-cause death. Thus patients with diabetes or a history of CVD can be treated with statins according to the guidelines of the Dutch College of General Practitioners.

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Authors and Affiliations

  1. Huisartsopleiding VUmc, De Boelelaan 1109, 1081, Amsterdam, HV, The Netherlands

    Anna Koning

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  1. Anna Koning
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Huisartsopleiding VUmc, De Boelelaan 1109, 1081 HV Amsterdam: A.S. Koning, huisarts • Correspondentie: koning.as@gmail.com • Mogelijke belangenverstrengeling: niets aangegeven.

Met ingang van dit nummer gaat de kennistoets niet meer over drie verschillende artikelen, maar over één artikel. Voor de eerste kennistoets nieuwe stijl is de keuze gevallen op ‘Statinetherapie bij 80-plussers: starten of staken?’. De kennistoets staat op pagina 83.

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Koning, A. Statinetherapie bij 80-plussers: starten of staken?. Huisarts Wet 59, 50–53 (2016). https://doi.org/10.1007/s12445-016-0041-0

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