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Statins for CV Prevention in Elderly Patients

Am J Med; ePub 2019 Jan 18; Bezin, et al

In a population-based cohort study, statin treatment was not associated with a reduction in acute coronary syndrome (ACS) or all-cause mortality in elderly patients without modifiable cardiovascular (CV) risk factor treated in primary prevention. New users of statins aged ≥75 years were dynamically included in the cohort and matched 1:1 to statin nonusers on age, gender, numbers of different drugs dispensed and medical consultations, and CV history. Among the details:

  • Patients were classified into 3 CV risk groups: secondary prevention (history of coronary heart disease), primary prevention with modifiable risk factors (diabetes or CV medications), and primary prevention without modifiable risk factors.
  • 7,284 patients were included; median follow-up was 4.7 years.
  • Cumulative use of statins was associated with a lower risk of outcomes in the primary prevention with modifiable risk factors group and in the secondary prevention group, but not in the primary prevention without modifiable risk factor group.

Citation:

Bezin J, Moore N, Mansiaux Y, Steg PG, Pariente A. Real-life benefits of statins for cardiovascular prevention in elderly subjects: A population-based cohort study. [Published online ahead of print January 18, 2019]. Am J Med. doi:10.1016/j.amjmed.2018.12.032.

Commentary:

The current ACC/AHA lipid lowering guideline suggests statin therapy for high risk patients aged 40 to 75 years. Data on statin outcomes is lacking for patients aged >75 years and LDL cholesterol levels become less predictive of events in older individuals. This French population-based cohort study evaluated CV outcomes in individuals aged ≥75 years. Patients with a history of CV disease and patients with modifiable risk factors achieved CV outcome reduction with statin therapy. Patients without CV disease and no modifiable risk factors did not have benefit from statin therapy. Patients without modifiable risk factors are at lower CV risk than the other risk groups. This suggests that statin therapy will achieve risk reduction based on the presence of risk factors but not based on age alone. The small cohort of elderly patients without CV risk factors may not benefit from statin therapy. —Matthew Sorrentino, MD

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