Statins in Healthy Older Adults Prevent Physical Disability, CVD

Statins appear to prevent physical disability and cardiovascular disease in healthy community-dwelling adults ≥70 years old, but do not prolong disability-free survival or avoid the risk of death or dementia, according to a study published June 29 in the Journal of the American College of Cardiology.

Using data from the double-blind, randomized ASPREE trial, researchers analyzed outcomes in 18,096 participants living in the U.S. and Australia, with a median age of 74.2 years; 56.0% were women. All participants were free of documented cardiovascular disease, dementia and disability. Cox proportional hazards regression with inverse probability weighting was used to compare outcomes in the 5,629 participants taking a statin at baseline vs. the 12,467 who did not.

The primary outcome was disability-free survival, defined as the combination of all-cause mortality, dementia or persistent physical disability. Other outcomes included the individual components of the primary outcome, along with major adverse cardiovascular events, fatal cardiovascular disease, myocardial infarction and stroke.

Throughout the follow-up period of a median of 4.7 years, there was 1,759 primary outcome events (884 deaths, 523 diagnoses of incident dementia, 352 physical disabilities). The unweighted incidence rate for the primary outcome was 20.8 and 21.9 per 1,000 patient-years in the statin user and nonuser groups, respectively, but in the Cox analysis there was no significant difference between the groups. Likewise, no significant difference was seen between groups for all-cause mortality or dementia. However, statin use was associated with a significantly lower risk for physical disability (weight-adjusted hazard ratio [HR], 0.75).

Statin use was also associated with significantly lower risk of major adverse cardiovascular events (weight-adjusted HR, 0.68), fatal cardiovascular disease (weight-adjusted HR, 0.71), myocardial infarction (weight-adjusted HR, 0.56) and stroke (weight-adjusted HR, 0.75).

Researchers did not find a significant interaction between statin use and age or sex on study outcomes.

To the authors' knowledge, this the first completed study to evaluate the association of statin use with disability-free survival, a robust measure of healthy, productive and independent life in older adults.

Zhen Zhou, MD, et al, wrote, "Given the observational nature of our analyses, they should not inform evidence-based therapeutic strategies. However, the study offers firsthand data that can inform the rationale of future clinical trials toward addressing the comprehensive role of statins in healthy older adults."

In an accompanying editorial comment, James N. Kirkpatrick, MD, FACC, and Gwen M. Bernacki, MD, MHSA, AACC, noted the study, "...has made a laudable contribution to the potential primary prevention of statin use in older adults and should not be relegated to the middle or end of a newscast. Rather, the much needed attention it brings to primary prevention of adverse outcomes in older adults deserves airtime, and in illustrating the importance of future randomized trials, it importantly calls us all to stay tuned."

Clinical Topics: Geriatric Cardiology, Prevention, Sleep Apnea

Keywords: ACC Advocacy, Aged, Cardiovascular Diseases, Independent Living, Double-Blind Method, Follow-Up Studies, Primary Prevention, Myocardial Infarction, Stroke, Dementia, Cardiology, Probability

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