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07-06-2024 | Geriatric Cardiology | Editor's Choice | News

Statin therapy reduces CVD risk and all-cause mortality in the over 75s

Author: Radhika Dua

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medwireNews: The use of statin therapy in individuals aged 75 years and older reduces the risk for cardiovascular diseases (CVDs) and all-cause mortality, with substantial benefits persisting in those aged 85 years and older, suggest findings from a target trial emulation study.

The study, conducted from 2008 to 2015, included 4,407,041 person–trials from 96 eligible trials emulated using real-world electronic health records from the Hong Kong Health Authority.

The researchers used propensity score matching to compare 97,462 individuals who initiated statin therapy with 97,462 who did not. Of these, 73,427 in each group were aged 60 to 74 years, 21,340 in each group were aged 75 to 84 years, and 2695 were aged 85 years or older.

The treatment regimen involved any dose of the following statins – simvastatin, atorvastatin, fluvastatin, rosuvastatin, lovastatin, pitavastatin, or pravastatin.

The patients who initiated statin treatment had up to one CVD risk factor, such as hypertension, obesity, and smoking, and a low-density lipoprotein (LDL) cholesterol of at least 4.1 mmol/L, two or more CVD risk factors with an LDL-cholesterol level of 3.4 mmol/L or above, or coronary heart disease (CHD) risk equivalents, including diabetes, peripheral vascular disease, hypertensive heart disease, or hypertensive chronic kidney disease.

The primary efficacy outcome was a composite of major CVDs – myocardial infarction, heart failure, and stroke – and all-cause mortality.

The study results, published in the Annals of Internal Medicine, found a significant reduction in the risk for overall CVD incidence with statin therapy across the different age groups over an average follow-up of 5.6 years.

In the intention-to-treat (ITT) analysis, statin therapy reduced the risk for CVD incidence by 11%, 6%, and 15% in adults aged 60–74 years, 75–84 years, and 85 years or older, respectively. In the per-protocol (PP) analysis, the corresponding risk reductions were 23%, 21%, and 35%.

The 5-year standardized absolute risk reduction for overall CVD incidence with versus without statin treatment in the ITT analysis was a significant 1.2 percentage points for adults aged 75–84 years (20.1 vs 21.3%, respectively) and 4.4 percentage points for those aged 85 years or older (30.0 vs 34.4%). In the PP analysis, the respective risk reductions were a significant 5.0 percentage points (19.9 vs 24.9%) and 12.5 percentage points (26.5 vs 39.0%).

This translated to a number needed to treat (NNT) to prevent one CVD event in 5 years of 20 for adults aged 75–84 years, and 8 for those aged 85 years or older.

The 5-year absolute risk reductions for all-cause mortality with versus without statins were also significant, at a respective 1.4 percentage points and 4.2 percentage points for patients aged 75–84 years (14.1 vs 15.5%) and 85 years or older (30.2 vs 34.4%) in the ITT analysis and 1.4 percentage points (16.2 vs 17.6%) and 6.9 percentage points (31.8 vs 38.7%) in the PP analysis.

The investigators point out that the reduction in CVD risk was seen in all subgroup analyses, including men and women, those with and without severe comorbid conditions (Charlson Comorbidity Index score of ≥6 vs <6 points), and those with and without CHD risk equivalents. Indeed, the findings suggested that “the benefits of statins in older adults were not solely limited to those with CHD equivalents,” they comment.

The researchers also highlight that the statin benefit seen in patients older than 75 years was not associated with a significant increase in the risk for the major adverse events of myopathies or liver dysfunction in any age group.

Owing to this finding, Eric Yuk Fai Wan (The University of Hong Kong, China) and colleagues say the results “confirmed the safety of statin therapy in old and very old adults.”

They conclude: “Considering the increasing burden related to CVD in the aging population, our study results support the prescription of statin therapy for primary prevention of CVD in old and very old adults.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group.

Ann Intern Med 2024; doi:10.7326/M24-0004

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