Association of Statin Use With Disability-Free Survival and CVD

Quick Takes

  • In healthy elderly, statin use may be beneficial for preventing physical disability and CVD, but not beneficial for prolonging disability-free survival or avoiding death or dementia in persons ≥70 years.
  • Two large randomized placebo-controlled studies of statins in the healthy elderly are in progress to assess the impact on overall quality of life including physical disability, dementia, MACE, and total mortality.

Study Questions:

What is the relationship between statin use and dementia-free and disability-free survival, and cardiovascular disease (CVD) among healthy older adults using data from the ASPREE (Aspirin in Reducing Events in the Elderly) trial?

Methods:

ASPREE was a randomized trial of 19,114 community-dwelling persons in Australia and the United States ≥65 years of age and free of documented CVD, dementia, and disability. Data were collected for those ≥70 years of age, and participants who took statins at baseline were compared with those who did not use Cox proportional hazards regression with inverse probability weighting. Primary outcome, referred to as “disability-free survival,” was a composite of all-cause mortality, dementia, or persistent physical disability. Other outcomes included the individual components of the composite outcome, major adverse cardiovascular events (MACE), fatal CVD, myocardial infarction (MI), and stroke.

Results:

Of the 18,096 included participants (median age 74.2 years, 56.0% women, >85 years 3.9%), 5,629 (31%) took statins at baseline. Over a median follow-up period of 4.7 years, baseline statin use was not associated with disability-free survival or with the risk for all-cause mortality or dementia. However, it was associated with lower risks for physical disability, and baseline statin use was associated with a significantly lower risk for physical disability, total MACE, fatal CVD, MI, and stroke.

Conclusions:

Among healthy community-dwelling adults ≥70 years of age, statin use may be beneficial for preventing physical disability and CVD, but not beneficial for prolonging disability-free survival or avoiding death or dementia. Future clinical trials are needed to confirm these findings.

Perspective:

Like many observational studies of lifestyle or specific medical treatments such as statins in atherosclerotic CVD within placebo-controlled studies of hypoglycemic drugs or aspirin in the ASPREE trial, large cohorts are necessary, and when assessing age-related effects, it is particularly difficult because of selection bias. This report was not able to accurately consider baseline low-density lipoprotein cholesterol (LDL-C) or effect of statin dosing. In a recent meta-analysis of randomized placebo-controlled statin trials including the elderly, there was a 21% proportional reduction in major CV events per ~40 mg/dl reduction in LDL-C, which decreased insignificantly with age, but was significant in all age groups. Two large randomized controlled studies assessing the impact of statins on total events and dementia and disability are in progress. Fortunately, well-designed studies have found no adverse effect of statins on memory or dementia even at very low levels of LDL-C and apolipoprotein B.

Clinical Topics: Dyslipidemia, Geriatric Cardiology, Prevention, Lipid Metabolism, Nonstatins, Sleep Apnea

Keywords: Aspirin, Cholesterol, LDL, Dementia, Disabled Persons, Geriatrics, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypoglycemic Agents, Independent Living, Life Style, Myocardial Infarction, Primary Prevention, Stroke, Survival, Vascular Diseases


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