Statins safe, offer benefits even in very old patients
Reductions in cardiovascular disease (CVD) after statin therapy were seen in patients up to ages 85 years or older without increasing risks for severe adverse effects.
Statin therapy was associated with lower incidence of cardiovascular disease (CVD) and all-cause mortality, even among people ages 85 years or older and did not increase the risk for adverse events such as myopathies and liver dysfunction, a study found.
In a target-trial emulation that mimicked a randomized clinical trial, electronic health records from the Hong Kong Health Authority were used to identify eligible patients from January 2008 to December 2015. Adults older than age 60 years who met criteria for starting statin therapy for primary prevention of CVD were included, while those with preexisting diagnosed CVD at baseline, such as coronary heart disease (CHD), were excluded.
Patients were divided into three age groups: 60 to 74 years, 75 to 84 years, and 85 years or older. Researchers matched statin users with nonusers and then analyzed the data for eligible patients from their baseline until December 2018, assessing outcomes such as CVD incidence, all-cause mortality, and adverse events. The article was published in Annals of Internal Medicine on May 28, along with an accompanying patient summary.
Incidence of major CVD (stroke, myocardial infarction, or heart failure), all-cause mortality, and major adverse events (myopathies and liver dysfunction) were determined. There were 42,680 matched person-trials ages 75 to 84 years and 5,390 matched person-trials ages 85 years or older and of these, 9,676 and 1,600 developed CVD. The five-year standardized risk reduction for overall CVD incidence with initiation of statin therapy was 1.20% (95% CI, 0.57% to 1.82%) in an intention-to-treat analysis and 5.00% (95% CI, 1.11% to 8.89%) in a per protocol analysis. In those ages 85 years or older, risk reduction was 4.44% (95% CI, 1.40% to 7.48%) and 12.50% (95% CI, 4.33% to 20.66%), respectively. Neither age group had significantly increased risks for myopathies and liver dysfunction.
The researchers acknowledged that their results may have been affected by unmeasured confounders such as lifestyle factors of diet and physical activity. "Considering the increasing burden related to CVD in the aging population, our study results support the prescription of statin therapy for primary prevention of CVD in old and very old adults," they concluded.