Are Statins Effective For Primary Prevention in Older Adults?

Statin use is not associated with reduced risk of atherosclerotic cardiovascular disease (CVD) or all-cause mortality in older adults free from diabetes, according to the results of a recent study.

While previous research supports the use of statins for secondary prevention of CVD in adults aged 75 years and older and primary prevention in those aged 65 years and older, no data is available on the effectiveness of statins for primary prevention in those aged 74 years and older or 84 years and older, according to the researchers.

They conducted a retrospective cohort study using data from 46,864 individuals aged 75 years and older without clinically recognized atherosclerotic CVD stratified by presence of type 2 diabetes and as new statin users or non-users.

In participants without diabetes, hazard ratios for statin use in those aged 75 to 84 years were 0.94 for atherosclerotic CVD and 0.98 for all-cause mortality. In those aged 85 years and older, they were 0.93 for atherosclerotic CVD and 0.97 for all-cause mortality.

In participants with diabetes, the hazard ratio for statin use in those aged 75 to 84 years was 0.76 for atherosclerotic CVD and 0.84 for all-cause mortality, and 0.82 and 1.05, respectively, in those aged 85 and older.

While statin use showed a protective effect against atherosclerotic CVD and all-cause mortality in participants with diabetes, this effect was “substantially reduced beyond the age of 85 years and disappeared in nonagenarians.”

“These results do not support the widespread use of statins in old and very old populations, but they do support treatment in those with type 2 diabetes younger than 85 years.”

—Michael Potts

Reference:

Ramos R, Comas-Cufi M, Marti-Lluch R, et al. Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study [Published online September 5, 2018] BMJ. https://doi.org/10.1136/bmj.k3359