Efficacy of statin treatment based on cardiovascular outcomes in elderly patients: a standard meta-analysis and Bayesian network analysis

Zhai, Chuannan; Hou, Kai; Li, Rui; Hu, Yuecheng; Zhang, Jingxia; Yingyi, Zhang; Wang, Le; Zhang, Rui; Cong, Hongliang

doi:10.1177/0300060520926349

Cited by 12 publications

(8 citation statements)

References 59 publications

(273 reference statements)

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“…The substantial statin benefits obtained for secondary prevention closely match the findings of Ponce et al for ASCVD events and mortality rate. Also in agreement with Ponce et al, in primary prevention statins were observed to significantly reduce the rate of myocardial infarction but not all-cause or cardiovascular mortality [ 76 ]. Despite this abundance of evidence from RCTs, two retrospective propensity score-matched studies in narrow populations recently reported reductions in all-cause mortality/ASCVD events in primary prevention adults aged 75+.…”

Section: Efficacy Of Statin Treatment In the Elderlysupporting

confidence: 87%

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Statin Treatment in Specific Patient Groups: Role for Improved Cardiovascular Risk Markers

White

Mishcon

Redwanski

et al. 2020

JCM

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Ample evidence supports the use of statin therapy for secondary prevention in patients with a history of atherosclerotic cardiovascular disease (ASCVD), but evidence is wanting in the case of primary prevention, low-risk individuals, and elderly adults 65+. Statins are effective in lowering low-density lipoprotein (LDL), which has long been a target for treatment decisions. We discuss the weakening dependence between cholesterol levels and mortality as a function of age and highlight recent findings on lipoprotein subfractions and other superior markers of ASCVD risk. The efficacy of statins is compared for distinct subsets of patients based on age, diabetes, ASCVD, and coronary artery calcium (CAC) status. Most cardiovascular risk calculators heavily weight age and overestimate one’s absolute risk of ASCVD, particularly in very old adults. Improvements in risk assessment enable the identification of specific patient populations that benefit most from statin treatment. Derisking is particularly important for adults over 75, in whom treatment benefits are reduced and adverse musculoskeletal effects are amplified. The CAC score stratifies the benefit effect size obtainable with statins, and forms of coenzyme Q are discussed for improving patient outcomes. Robust risk estimator tools and personalized, evidence-based approaches are needed to optimally reduce cardiovascular events and mortality rates through administration of cholesterol-lowering medications.

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Section: Efficacy Of Statin Treatment In the Elderlysupporting

confidence: 87%

“…In 2020, a meta-analysis was performed based on 17 RCTs in elderly patients 65+ for primary or secondary prevention [ 76 ]. The substantial statin benefits obtained for secondary prevention closely match the findings of Ponce et al for ASCVD events and mortality rate.…”

Section: Efficacy Of Statin Treatment In the Elderlymentioning

confidence: 99%

Statin Treatment in Specific Patient Groups: Role for Improved Cardiovascular Risk Markers

White

Mishcon

Redwanski

et al. 2020

JCM

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“…As for most preventive drugs in cardiovascular disease, the evidence underpinning recommendations for secondary prevention of stroke is weaker in patients aged 75 years or more. Several analyses though, have indicated that the preventive effects seem to be as good in the elderly as in younger patients 21. Most international and national guidelines thus, do not discern patients based on age.…”

Section: Discussionmentioning

confidence: 99%

“…Several analyses though, have indicated that the preventive effects seem to be as good in the elderly as in younger patients. 21 Most international and national guidelines thus, do not discern patients based on age.…”

Section: Discussionmentioning

confidence: 99%

Identifying factors explaining practice variation in secondary stroke prevention in primary care: a cohort study based on all patients with ischaemic stroke in the Stockholm region

Wolf

Hasselström²,

Carlsson³

et al. 2022

BMJ Open

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ObjectivesThe aim of this study was to describe the practice variation in dispensation of secondary stroke preventive drugs among patients at different primary care centres (PCCs) in Stockholm region and to identify factors that may explain the variation.DesignCohort study using administrative data from the Stockholm region.SettingStockholm Health Care Region, Sweden, serving a population of 2.3 million inhabitants, hospital and PCC data.ParticipantsAll patients (n=9761) with ischaemic stroke treated in hospital from 1 July 2009 to 30 June 2014 were included. Of these, 7562 patients registered with 187 PCCs were analysed. Exclusion criteria were; deceased patients, age <18, haemorrhagic stroke and/or switching PCC.Primary and secondary outcome measuresAs primary outcome the impact of PCC organisation variables and patient characteristics on the dispensation of statins, antiplatelets, antihypertensives and anticoagulants were analysed. Secondarily, the unadjusted practice variation of preventive drug dispensation of 187 PCCs is described.ResultsThere was up to fourfold practice variation in dispensation of all secondary preventive drugs. Factors associated with a lower level of dispensed statins were privately run PCCs (OR 0.91 (95% CI 0.82 to 1.00)) and the patient being woman. Increased statin use was associated with a higher number of specialists in family medicine (OR 1.03 (95% CI 1.01 to 1.05)) and a higher proportion of patients registered with a specific physician (OR 1.37 (95% CI 1.11 to 1.68)). Women had on average a lower number of dispensed antihypertensives.ConclusionsA high practice variation for dispensation of all secondary preventive drugs was observed. Patient and PCC level factors indicating good continuity of care and high level of general practitioner education were associated with higher use of statins. Findings are of importance to policymakers as well as individual providers of care, and more research and actions are needed to minimise inequality in healthcare.

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“… 16 , 17 In congruence with this, a meta‐analysis of 17 statin trials found statin treatment to reduce the risk of all‐cause mortality and recurrent stroke. 18 …”

Section: Discussionmentioning

confidence: 99%

Stroke Recurrence Following 28 Days After First Stroke in Men and Women 2012 to 2020: Observations From the Swedish Stroke Register

Eriksson

Grundberg

Inge

et al. 2023

JAHA

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Background Stroke incidence, care, and survival show continuous improvements in Sweden, including no or decreasing disparities between men and women. In this study, we aimed to estimate and compare the risk of stroke recurrence in men and women over time, accounting for the competing risk of death. Methods and Results We included adult patients with first‐time stroke (ischemic or intracerebral hemorrhage) registered in Riksstroke (the Swedish Stroke Register), 2012 to 2020, and followed until December 2020. Stroke recurrences included new events registered in Riksstroke from 28 days after stroke. To account for the competing risk of death, we used the cumulative incidence function to estimate crude incidences, and multivariable Cox regression to estimate cause‐specific hazard ratios (HRs) adjusting for differences in patients' risk factor profiles. The study included 72 148 (53.5%) men and 62 689 (46.5%) women. We observed 10 925 stroke recurrences and 81 811 deaths following the initial 28 days after the first stroke. The cumulative incidence of stroke recurrence was 3.7% (95% CI, 3.6–3.8) after 1 year, 7.0 (95% CI, 6.8–7.1) after 3 years, and 9.1% (95% CI, 8.9–9.3) after 5 years. The incidence decreased substantially during the study period (HR, 2019–2020 versus 2012, 0.824 [95% CI, 0.759–0.894]). Overall, men had a lower risk of stroke recurrence. After adjustments for differences in patient characteristics, men had a slightly higher risk of recurrence (of any type) after an ischemic stroke (HR, 1.090 [95% CI, 1.045–1.138]) and a lower risk after hemorrhagic stroke (HR, 0.880 [95% CI, 0.781–0.991]) compared with women. Conclusions The risk of stroke recurrence has decreased in both men and women. Women's higher age and other differences in risk factors partly explain their higher risk of stroke recurrence compared with men.

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Efficacy of statin treatment based on cardiovascular outcomes in elderly patients: a standard meta-analysis and Bayesian network analysis

Cited by 12 publications

References 59 publications

Statin Treatment in Specific Patient Groups: Role for Improved Cardiovascular Risk Markers

Statin Treatment in Specific Patient Groups: Role for Improved Cardiovascular Risk Markers

Identifying factors explaining practice variation in secondary stroke prevention in primary care: a cohort study based on all patients with ischaemic stroke in the Stockholm region

Stroke Recurrence Following 28 Days After First Stroke in Men and Women 2012 to 2020: Observations From the Swedish Stroke Register

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