Association between guideline recommended drugs and death in older adults with multiple chronic conditions: population based cohort study

When prescribing medications for the initiation of  a new therapy in patients with multiple chronic diseases, physicians often look to guidelines to determine their recommended treatment option.  While this is considered good practice, it is important to not look at the disease state as a singular entity when choosing a therapy for the patient to follow due to the effects that certain conditions have on one another. This study looked to analyze the association between guideline recommended drugs and death in older adults with multiple chronic disease states. To do this, 8578 adults aged 65 and older were monitored though three years of treatment. Patients involved in the study had a variety of disease states including but not limited to atrial fibrillation, chronic kidney disease, depression, diabetes,  and hyperlipidemia. Results from the study showed that over 50% of the participants received guideline recommended drugs without the consideration of other disease states. Although 15% of the patients died during the course of the study, researchers were able to determine that cardiovascular medications were associated with a decrease in mortality. Other guideline medications analyzed in the study did not show an association with reduced mortality. Overall, it was determined that choosing medication therapy for patients should only be done after fully analyzing the patients other conditions.

I believe this study is important due to the fact that guideline recommended medications are commonly dispensed in the pharmacy setting. It is thus important for us to understand how guideline drugs interact with each other to protect a patient at the point of treatment initiation. By doing this, we will be able to avoid adverse drug effects that can result due to medication interactions. I believe that this is one of the most important roles of a pharmacist because it helps promote patient well-being and increases the likelihood of medication regiment adherence. The goal of our profession is to protect patients and advise them on how to find ways to live a healthy lifestyle. The easiest way to do this is by starting at the roots of the solution.

Tinoetti M, 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

Primary prevention with lipid lowering drugs and long term risk of vascular events in older people: population based cohort study

The objective of this study was to determine if the use of statins or fibrates in an older population with no history of cardiovascular events affected the risk of coronary heart disease and stroke. The study used a random sample of 7484 individuals(63% female) aged 65 or older from three french cities.

The study found that those using either drug were at a decreased risk of stroke compared to those not using a lipid lowering drug, however no association was found between those using either drug and a decreased risk of coronary heart disease. The researchers analyzed the data based on age, sex, body mass index, and hypertension amongst other variables, and found that overall there was a 30% decrease in risk of stroke for those using a lipid lowering drug.

I think this study is important for understanding the use of statins and fibrates. With the data from this study, there appears to be a clear indication for the use of statins or fibrates for stroke prevention, however there doesn’t seem to be an indication for the use of either drug in prevention of coronary artery disease. With this knowledge, we can help prevent drug therapy problems and recommend that different drugs should be used to prevent coronary heart disease.

Link to study