About this Research Topic
With the number of older individuals increasing significantly in our societies, the number of individuals with (cardiovascular) comorbidities is increasing as well. This increased prevalence of comorbidities is accompanied by an increased use of cardiovascular drugs, including cholesterol-lowering and blood pressure-lowering medication, for the prevention of morbidity and mortality. Older individuals are at an increased risk of developing adverse drug reactions due to several factors, which includes changing drug metabolism as well as the presence of drug-drug interactions.
Older individuals (usually defined as individuals aged 65 years and older) are underrepresented in randomized clinical trials examining the effectiveness and safety of cardiovascular medications. Importantly, the older individuals that are usually included in the randomized clinical trials are frequently highly selected which limits generalization of the research findings to the general older populations. Therefore, there is a significant gap in knowledge addressing the fundamental clinical questions whether cardiovascular drugs are safe and effective for use in older individuals, as well as in combinations with concomitantly used medications. On the other hand, observational studies are frequently harmed by forms of bias and confounding, which includes confounding by indication and contraindication. Furthermore, there are ongoing discussions whether cardiovascular medication is still of benefit to patients with limited life expectancy. The current challenge in the field is to design observational studies addressing safety and effectiveness of cardiovascular medication in older individuals taking into account these methodological challenges and to attempt causal inference of the research findings. This Research Topic is specifically intended to create a basis of studies examining the safety and effectives of cardiovascular medications on the basis of in particular observational databases (e.g., cohort studies, health care databases) in older individuals, and to apply advanced research methods for improved causal inference and generalizability of the research findings.
For this Research Topic, we specifically invite authors to contribute with Original Research articles investigating outcomes of drugs targeting the cardiovascular system in the older population. For this Research Topic, we are especially interested in articles addressing intended as well as adverse effects of cardiovascular drug use and comparisons between young and older individuals. Furthermore, this Research Topic also invites authors to submit manuscripts describing the safety of stopping cardiovascular medication in older patients with low life expectancy. These studies can be performed using observational databases, which includes cohort studies and health care databases. However, we also invite authors to submit work from randomized clinical trials when the authors can make sure the results are generalizable to the larger older (>65 years) population. This Research Topic is also in particular interested in manuscripts presenting new research tools and statistical methods for addressing drug response, drug safety and drug-drug interactions in observational studies.
Keywords: Cardiovascular drugs, elderly, observational research, effectiveness, adverse drug reactions
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