Management of dyslipidemia in elderly diabetic patients.
The prevalence of diabetes increases with age, potentially affecting 20% of the 75 years and older elderly population. Overmortality and increased cardiovascular morbidity-mortality are common in diabetic populations, including elderly diabetes. This increased cardiovascular risk must therefore be taken into consideration when discussing management of dyslipidemia in elderly diabetics. Should dyslipidemia be treated in elderly diabetics? What are the objectives and with what means? Whether the significance of dyslipidemia is different in this growing population compared with younger subjects remains unknown due to the lack of specific studies. The only results available come from a few primary or secondary cardiovascular prevention trials using statins or fibrates with subgroups of elderly diabetic patients, or subgroups of diabetic patients and also subgroups of patients aged over 65. Three recent studies detailed the potential benefit of such treatment: PROSPER in elderly subjects aged 70-82 years, HPS in diabetics before and after the age of 70 years and CARDS in diabetics aged up to 75 years. The results of these studies provide a few indirect elements of interest, keeping in mind the generally higher iatrogenic risk of treatment in elderly populations.