Article written by Bruce Sylvester
Elderly patients without atherosclerotic cardiovascular disease (ASCVD) who initiated statin therapy have achieved a 25% reduction in the risk of early death..
..researchers reported on July 7, 2020 in JAMA/Journal of the American Medical Association.
“The findings of the study by Orkaby et al provide additional support for treatment guidelines that have increasingly advocated for more widespread use of statin therapy for ASCVD prevention in older individuals…. Because patients older than 75 years represent one of the fastest-growing population subgroups in health care systems, there is a major need to provide an evidence base that informs use of therapies that are both safe and efficacious, in a cost-effective manner. To achieve this goal, additional rigorous studies in these patients are needed to determine the most optimal approach to delivering health care to the oldest members of society,” said Stephen J. Nicholls, MBBS, PhD of Monash University in Clayton, Australia and Adam J. Nelson, MBBS, PhD, of the University of Adelaide in Adelaide, Australia, in an accompanying editorial.
The study was retrospective, and investigators utilized Veterans Health Administration (VHA) data on adults 75 years and older, free of ASCVD, and with a clinical visit in 2002-2012.
The researchers tracked data through December 31, 2016. All information was linked to Medicare and Medicaid claims and pharmaceutical data.
They excluded anyone with any prior statin use.
Eligible subjects received, “any new statin prescription.”
The primary outcomes were all-cause mortality and cardiovascular mortality. Secondary outcomes included a composite of ASCVD events (myocardial infarction, ischemic stroke, and revascularization with coronary artery bypass graft surgery or percutaneous coronary intervention).
Of 326,981 eligible veterans (mean age 81.1, 97% men, 91% white), 57,178 (17.5%) began taking a statin for the first time during the study period.
During a mean follow-up of 6.8 years, 206,902 deaths occurred including 53.296 cardiovascular deaths.
There were 79 and 98 total deaths/1000 person-years among statin users and nonusers, respectively.
For the composite ASCVD outcome there were 123,379 events, with 66 and 70 events/1000 person-years among statin users and nonusers, respectively.
When comparing statin users with nonusers the hazard ratio was 0.75 (25% reduction) for cardiovascular mortality, and 0.92 (8% reduction) for a composite of ASCVD events.
The authors concluded, “Among US veterans 75 years and older and free of ASCVD at baseline, new statin use was significantly associated with a lower risk of all-cause and cardiovascular mortality. Further research, including from randomized clinical trials, is needed to more definitively determine the role of statin therapy in older adults for primary prevention of ASCVD.”