Statins improve survival among elderly

Article written by Bruce Sylvester

A large and retrospective study of the medical records U.S. veterans suggests that new statin use after age 75 is strongly associated with a decreasing risk of death.

Researchers reported their findings on July 7, 2020 in the NEJM/New England Journal of Medicine.

“Among US veterans 75 years and older and free of ASCVD [atherosclerotic cardiovascular disease] at baseline, new statin treatment 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,” the authors said.

As background, they noted that many prior studies have shown that statins can prevent heart attacks, strokes and death in middle-aged adults. But only 2 per cent of the subjects in 28 major clinical trials of statins have been 75 years or older. So, little data has been developed to support the hypothesis that statins will work to such therapeutic ends in this elderly population.

In this new study, investigators from Brigham and Women’s Hospital and the VA Boston Healthcare System gathered and analyzed national data from the U.S. Veterans Health Administration Services and Centers for Medicare & Medicaid Services. They investigated the prophylactic value of statins for older adults who have not yet had a heart attack, stroke or other cardiovascular event.

There were 326,981 eligible veterans (mean 81.1 years; 97% men; 91% white) of whom 57, 178 (17.5%) initiated statins during the study period. The first clinical visit in which a first-use statin was prescribed happened between 2O20 and 2012. Follow-up continued through December 31, 2016.

The primary outcomes were all-cause 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).

During a mean follow-up of 6.8 years, 206,902 deaths occurred including 53, 296 cardiovascular deaths, with 78.7 and 98.2 total deaths/1000 person-years among statin users and nonusers, respectively.

There were 22.6 and 25.7 cardiovascular deaths per 1000 person-years among statin users and nonusers, respectively.

For the composite ASCVD/atherosclerotic cardiovascular disease endpoint, there were 123,379 events, with 66.3 and 70.4 events/1000 person-years among statin users and nonusers, respectively.

After standard statistical analyses, the hazard ratio was 0.75 (25% reduction) for all-cause mortality, 0.80 (20% reduction) for cardiovascular mortality, and 0.92 (8% reduction) for a composite of ASCVD events, when comparing statin users to nonusers.

“Based on these data, age is not a reason to not prescribe statins,” said author Ariela Orkaby, MD, MPH, a physician scientist at the VA Boston Health Care System and in the Division of Aging at the Brigham and Women’s Hospital in Boston. “Statins are commonly studied and prescribed for middle-aged adults but understudied in people over age 75. One of the most remarkable things about our results is that we found the benefit of statins held true regardless of whether a person was older or younger or had a condition such as dementia.”