Do Cardiovascular Drugs Benefit Older Adults with Chronic Conditions?

The average survival benefits of cardiovascular drugs in older patients with multiple comorbidities are similar to those seen in randomized, controlled trials, but vary depending on coexisting conditions, according to a recent study.

In order to estimate the association between guideline recommended drug treatments and survival, researchers conducted an observational study involving 8578 older adults (mean age 77 years) with 2 or more of the following conditions: atrial fibrillation, coronary artery disease, chronic kidney disease, depression, diabetes, heart failure, hyperlipidemia, hypertension, and thromboembolic disease.
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Overall, 50% of participants with each condition were given guideline recommended drugs regardless of coexisting conditions, and 15% of the total participants died.

Survival benefits were observed with calcium-channel blockers, beta-blockers, statins, and renin-angiotensin system blockers, compared against participants not given guideline-recommended treatments.

No survival benefits were observed with clopidogrel, selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, or metformin, and benefits with warfarin varied by comorbidity.

“Eventually, more individualized estimates, perhaps ascertained through large well characterized databases of people with major complications and comorbidities may guide treatment decisions with the aim of maintaining the beneficial effects of drugs while reducing the burden and risk of adverse effects of polypharmacy,” they concluded.

“Eventually it should be possible to estimate and compare benefits of several guideline recommended drugs for any given combination of conditions.”

—Michael Potts

 Reference:

Tinetti ME, McAvay G, Trentalange M, et al. Association between guideline recommended drugs and death in older adults with multiple chronic conditions: population based cohort study. BMJ. 2015;351:h4984.