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New statin use in older adults is associated with a significantly lower risk of all-cause and cardiovascular mortality, a study in the Journal of the American Medical Association has suggested (7 July 2020).
The retrospective cohort study analysed data from 326,981 US veterans aged 75 years old or older who had not previously had a heart attack, stroke or other cardiovascular event.
During the study period, 57,178 (17.5%) of the study cohort were using newly prescribed statins, most commonly simvastatin. Follow-up continued for a mean of 6.8 years and during that time a total of 206,902 deaths occurred, with 78.7 and 98.2 total deaths per 1000 person-years occurring among statin users and non-statin users, respectively.
Of these, there were 22.6 cardiovascular deaths per 1,000 person-years among statin users compared with 25.7 cardiovascular deaths per 1,000 person-years among non-statin users.
In terms of the secondary outcomes — which included a composite of cardiovascular events, such as heart attack and stroke — there were a total of 123,379 events, of which 66.3 and 70.4 events per 1,000 person-years occurred among statin users and non-statin users, respectively.
Using propensity scoring, the authors compared individuals who began taking statins with those who had the same likelihood of being prescribed a statin based on clinical characteristics, but did not receive a prescription for the drug.
Overall they found that there was a 25% (hazard ratio [HR] 0.75, 95% confidence interval [CI] 0.74–0.76) reduction in all-cause mortality and a 20% (HR 0.80, 95% CI 0.78–0.81) reduction in cardiovascular mortality when comparing statin users with non-statin users.
They also calculated an 8% (HR 0.92, 95% CI 0.91–0.94) reduction in the risk of a composite of cardiovascular events for statin users.
These benefits remained for veterans aged 90 years or older.
“Based on these data, age is not a reason to not prescribe statins,” said Ariela Orkaby, a physician scientist at the VA Boston Health Care System and lead author of the study.
“Statins are commonly studied and prescribed for middle-aged adults but understudied in people over age 75 [years],” she explained.
“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.”
Orkaby added that the study highlighted many interesting leads to follow up on but said it was important to “keep in mind” that it was not a randomised clinical trial.
Paul Wright, lead cardiac pharmacist at Barts Health NHS Trust, said the paper added to the “growing” body of evidence on the benefits of statins in a “significantly underrepresented” subset of patients.
“Despite an ageing population, there is little data to support clinicians, and patients, making a decision on starting treatment with a statin to prevent atherosclerotic cardiovascular events,” he said.
“During the time frame of patients analysed (2002–2012), most patients were taking simvastatin 40mg for which most international guidelines now suggest atorvastatin for which this study may underestimate the true benefit.
“There are some age-specific statin trials nearing completion, but until these are published, this study should give confidence to clinicians and patients alike that provided there are no contraindications, there are significant gains to be had ignoring a patient’s age.”
