Health
75 years or older? Statins are still associated with primary prevention outcomes
Extensive veterans health data show that people aged 75 and older who took statins for the primary prevention of atherosclerosis (ASCVD) had good clinical outcomes for many years.
Statin users in that age group had a significantly lower risk of events with an average of 6.8 years of follow-up compared to non-users:
- 25% reduction in all-cause mortality (78.7 vs. 98.2 per 1,000 person-years)
- 20% reduction in cardiovascular mortality (22.6 vs. 25.7 per 1,000 person-years)
- 8% reduction in combined ASCVD events (MI, ischemic stroke, and revascularization with coronary artery bypass surgery or percutaneous coronary intervention); 66.3 vs 70.4 events/1,000 person-years)
“The results were consistent in older and co-morbid patients, with similar risk of death among statin users over 90 and dementia,” said a research team led by MPH, Ariela Orkaby, MD, VA Boston. “. Medical system. Their manuscript is Published in JAMA..
The results are notable given that older people were explicitly excluded from the primary statin trials and lack of safety and efficacy data for this large population.
Orcabie and his colleagues pointed out that their results support the 2018 Cholesterol Guidelines of the American Heart Association and the American College of Cardiology. 75 years or older..
“These findings show that the use of statins for primary prevention in older patients, according to editors from Stephen Nicholls, MBBS, PhD from Monash University in Melbourne, Australia, and Adam Nelson from Duke Clinical, editorial department. Provides a compelling discussion about The Institute in Durham, NC.
“Both baseline LDL cholesterol levels and statin therapy intensity and adherence have not been reported, New statin prescription It was obvious in these patients.”
A retrospective cohort study identified 326,981 US veterans aged 75 years and older who had no ASCVD at baseline and had no prescription for statins between 2002 and 2012.
Medicare and Medicaid claims and pharmacy records determined that 17.5% of the cohort began taking statins (most commonly simvastatin) during the study period.
Despite investigators’ efforts to make statistical adjustments, unmeasured confounding is still possible, they said. Another limitation of this study was the fact that modern practice prefers high-intensity statins, unlike the statins frequently used in cohorts.
The study participants were on average 81.1 years old, almost all men (97.3%) and whites (91%).
“It remains unclear how the findings can be applied to women and more diverse populations. This reaffirms the need for a more comprehensive cohort to build the evidence base needed by treatment guidelines. Nichols and Nelson wrote.
The study authors note that especially randomized trials are needed to provide more information about the safety and efficacy of statins in the elderly. for that reason, STAREE And Preventable A trial is in progress.
Cognitive impairment And muscle pain It has often been cited as a patient concern about taking statins.
“Patients aged 75 and over are one of the fastest growing population subgroups in the healthcare system, so there is an evidence base that informs the use of safe and effective treatments in a cost-effective manner. Must be provided, said the editor-in-chief.
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Disclosure
This work was funded by the Virginia State Institute and the National Institute on Aging Grants.
Orkaby and Nelson did not disclose.
Nichols receives research support from the Australian National Health and Medical Research Council, AstraZeneca, Amgen, Ansera, Eli Lilly, Novartis, Serenith, The Medicines Company, Lesvar Logix, Infraredox, Roche, Sanofi Regeneron and Liposcience. I reported. You will receive consulting fees and honors from AstraZeneca, Eli Lilly, Anthera, Omthera, Merck, Takeda, Resverlogix, Sanofi-Regeneron, CSL Behring, Esperion, and Boehringer Ingelheim.
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