Real-Life Benefits of Statins for Cardiovascular Prevention in Elderly Subjects: A Population-Based Cohort Study.

Julien Bezin, Nicholas Moore, Yohann Mansiaux, Philippe Gabriel Steg, Antoine Pariente

REVIEW


23 May 2019

This paper highlights an important area and answers a key question, since older patients are traditionally excluded from clinical trials. It confirms trials of comparative effectiveness of statins in other people.


RELEVANCE 3
INNOVATIVENESS 4
APPLICABILITY 3
OVERALL 3

PAPER DETAILS


TITLE

Real-Life Benefits of Statins for Cardiovascular Prevention in Elderly Subjects: A Population-Based Cohort Study.

ABSTRACT

OBJECTIVES
The benefits of initiating statins in the elderly remains debated. We evaluated the effects of initiating statins in the elderly, according to cardiovascular risk.

METHODS
This population-based cohort study used data of the representative sample of the French health care system database for the 2008-2015 period. New users of statins, aged 75 years and older, were dynamically included in the cohort and matched 1:1 to statin nonusers on age, sex, numbers of different drugs dispensed and medical consultations, and cardiovascular history. Patients were classified into 3 cardiovascular risk groups: secondary prevention (history of coronary heart disease), primary prevention with modifiable risk factors (diabetes or cardiovascular medications), and primary prevention without modifiable risk factors (none of the above). Effect of cumulative use of statins on occurrence of acute coronary syndrome or all-cause death was analyzed by using multivariable time-dependent Cox models stratified on cardiovascular risk at inclusion.

RESULTS
Among the 7284 patients 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 (adjusted hazard ratio 0.93 per year of use; 95% confidence interval, 0.89-0.96; P < .01) and in the secondary prevention group (0.75; 0.63-0.90; P < .01), but not in the primary prevention without modifiable risk factors group (1.01; 0.86-1.18; P = .92).

CONCLUSIONS
Statin treatment was not associated with a reduction in acute coronary syndrome or all-cause death in elderly without modifiable cardiovascular risk factor treated in primary prevention.



AUTHOR(S)

Julien Bezin, Nicholas Moore, Yohann Mansiaux, Philippe Gabriel Steg, Antoine Pariente,

JOURNAL

The American journal of medicine

PLACE

United States