Statin Use and Risk for CVD or Death in Older Adults

Quick Takes

  • This cohort study suggests statin use for primary prevention is beneficial in lowering all-cause mortality among adults aged ≥75 years.
  • Both cardiovascular mortality and ASCVD events were lower among statin users compared with nonstatin users.

Study Questions:

Are statins associated with a lower risk for mortality among older adults with no prior history of atherosclerotic cardiovascular disease (ASCVD)?

Methods:

The present study used a retrospective cohort study design, using Veterans Health Administration (VA) data. Veterans aged ≥75 years who were free of ASCVD at baseline and had a clinic visit between 2002 and 2012 were included. Data were linked to Medicare and Medicaid claims and pharmaceutical data. Patients who had any new statin prescriptions were compared to those who did not, with the primary outcomes being all-cause and CV mortality. Secondary outcomes included ASCVD events (myocardial infarction, ischemic stroke, and revascularization with coronary artery bypass graft surgery or percutaneous coronary intervention). Outcomes were identified through December 2016.

Results:

A total of 7,242,193 veterans, aged ≥75 years, who had at least one visit at the VA between 2002-2016, were identified. Of the 648,677 with no prior statin use, 317,488 were excluded either for having a history of CVD at baseline, or for missing data. An additional 4,213 were excluded due to death in the first 150 days from baseline. This left 326,981 veterans in the cohort (mean age 81.1 years, 97% were men, and 91% were white). A total of 57,178 (17.5%) of these patients had newly initiated statins during the study period. Over an average of 6.8 years of follow-up, 206,902 deaths occurred, including 53,296 CV mortality, with 78.7 and 98.2 total deaths/1,000 person-years among statin users and nonusers, respectively. There were 22.6 and 25.7 CV deaths per 1,000 person-years among statin users and nonusers, respectively. For the composite ASCVD outcome, there were 123,379 events, with 66.3 and 70.4 events/1,000 person-years among statin users and nonusers, respectively. After propensity score overlap weighting was applied, the hazard ratio (HR) was 0.75 (95% confidence interval [CI], 0.74-0.76) for all-cause mortality, and HR, 0.80 (95% CI, 0.78-0.81) for CV mortality for statin users compared to nonusers. The HR for a composite of ASCVD events was 0.92 (95% CI, 0.91-0.94), comparing statin users with nonusers.

Conclusions:

The authors concluded that among US veterans aged ≥75 years and free of ASCVD at baseline, new statin use was significantly associated with a lower risk of all-cause and CV mortality.

Perspective:

Although not a randomized controlled trial, these data suggest that statins may be of benefit for primary prevention in older adults. Trials that address the potential benefit of statins in those aged ≥75 years are warranted. Furthermore, study populations that include higher numbers of women and with greater ethnic diversity are needed.

Clinical Topics: Cardiac Surgery, Diabetes and Cardiometabolic Disease, Dyslipidemia, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery

Keywords: Atherosclerosis, Brain Ischemia, Coronary Artery Bypass, Dyslipidemias, Geriatrics, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Myocardial Infarction, Myocardial Revascularization, Percutaneous Coronary Intervention, Risk, Stroke, Veterans, Veterans Health


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