Statins for Primary Prevention of Cardiovascular Events and Mortality in Older Men.

Ariela R Orkaby, J Michael Gaziano, Luc Djousse, Jane A Driver

REVIEW


21 January 2019

A highly relevant and important paper that will help choice of statin prescribing in the elderly.


RELEVANCE 4
INNOVATIVENESS 4
APPLICABILITY 5
OVERALL 4

PAPER DETAILS


TITLE

Statins for Primary Prevention of Cardiovascular Events and Mortality in Older Men.

ABSTRACT

BACKGROUND/OBJECTIVES
We sought to determine whether statin use for primary prevention is associated with a lower risk of cardiovascular events or mortality in older men.

DESIGN
Prospective cohort study.

SETTING
Physicians' Health Study participants.

PARTICIPANTS
7,213 male physicians ≥70 years without a history of cardiovascular disease (CVD).

MEASUREMENTS
Multivariable propensity score for statin use with greedy matching (1:1) to minimize confounding by indication.

RESULTS
Median baseline age was 77 (70-102), median follow-up was 7 years. Non-users were matched to 1,130 statin users. Statin use was associated with an 18% lower risk of all-cause mortality, HR 0.82 (95% CI 0.69-0.98) and non-significant lower risk of CVD events, HR 0.86 (95% CI 0.70-1.06) and stroke, HR 0.70 (95% CI 0.45-1.09). In subgroup analyses, results did not change according to age group at baseline (70-76 or >76 years) or functional status. There was a suggestion that those >76 at baseline did not benefit from statins for mortality, HR 1.14 (95% CI 0.89-1.47), compared to those 70-76 at baseline, HR 0.83 (95% CI 0.61-1.11); however the CIs overlap between the two groups, suggesting no difference. Statin users with elevated total cholesterol had fewer major CVD events than non-users, HR 0.68 (95% CI 0.50-0.94) and HR 1.43 (95% CI 0.99-2.07)), respectively.

CONCLUSIONS
Statin use was associated with a significant lower risk of mortality in older male physicians ≥70 and a nonsignificant lower risk of CVD events. Results did not change in those who were >76 years at baseline or according to functional status. There was a suggestion that those with elevated total cholesterol may benefit. Further work is needed to determine which older individuals will benefit from statins as primary prevention.



AUTHOR(S)

Ariela R Orkaby, J Michael Gaziano, Luc Djousse, Jane A Driver,

JOURNAL

Journal of the American Geriatrics Society

PLACE

United States