The role of medications in successful aging

Abstract

Successful aging includes good health and low levels of disability. To that end, primary prevention is far better than managing subsequent organ damage. When medication is needed to prevent or manage disease, the preferred choice should be associated with the greatest benefits and fewest adverse effects. Cardiovascular diseases are the leading cause of morbidity and mortality in postmenopausal women worldwide. Considering disease-adjusted life years, other leading causes are chronic obstructive pulmonary disease, diabetes mellitus, dementias, hearing loss, cancers of the breast, lung and bowel, osteoporosis, fractures and falls, depression, osteoarthritis, refractive errors of the eye and non-diabetic chronic kidney disease. This review explores the global prevalence of these diseases in women aged 50 years and older, and medications commonly used for them, and contrasts the effects of menopausal hormone therapy (MHT) with others. When initiated early, there is good evidence for MHT benefit in all-cause mortality and primary prevention of cardiovascular disease, diabetes and osteoporosis; fair evidence for benefit in dementias, depression and osteoarthritis; limited evidence for benefit in chronic obstructive pulmonary disease, hearing loss, non-diabetic chronic kidney disease and colorectal cancer; null effects on lung cancer and refractive errors; and varied effects on breast cancer and stroke. Relative benefits and adverse effects of other medications warrant consideration.

药物在健康老龄化中的作用 摘要

健康的老龄化包括良好的健康和较低的残疾水平。为此, 初级预防远胜于器官损伤后再治疗。当需要药物来预防或管理疾病时, 应当首选收益最大和副作用最小的方法。心血管疾病是全世界绝经后妇女发病和死亡的主要原因。考虑到疾病对寿命的影响, 其他主要病因为慢性阻塞性肺病、糖尿病、痴呆、听力损失、乳腺癌、肺癌和肠癌、骨质疏松症、骨折和跌倒、抑郁症、骨关节炎、眼睛屈光不正和非糖尿病性慢性肾病。本综述探讨了在全球50岁及以上妇女中这些疾病的流行情况, 以及常用的治疗方法, 并对比了绝经后激素疗法(MHT)与其他治疗的效果。如果早期开始治疗, 有充分证据表明MHT在全因死亡率和心血管疾病、糖尿病和骨质疏松症的一级预防方面有益处；对痴呆、抑郁症和骨关节炎有充足的证据表明获益；在慢性阻塞性肺疾病、听力损失、非糖尿病慢性肾脏疾病和结肠直肠癌中获益的证据有限；对肺癌和屈光不正无效；以及对乳腺癌和中风有不同影响。其他药物的相对益处和副作用也值得考虑。

Keywords:

• Menopause
• disability-adjusted life year
• primary prevention
• menopausal hormone therapy
• aging
• medications
• chronic diseases
• women’s health

Potential conflict of interest

R. D. Langer reports personal fees from Pfizer India Limited, outside the submitted work.

Source of funding

Nil.