Hydroxymethylglutaryl‐CoA Reductase Inhibitors in Older Persons with Acute Myocardial Infarction: Evidence for an Age–Statin Interaction

Foody, JoAnne M.; Rathore, Saif S.; Galusha, Deron; Masoudi, Frederick A.; Havranek, Edward P.; Radford, Martha J.; Krumholz, Harlan M.

doi:10.1111/j.1532-5415.2005.00635.x

Cited by 67 publications

(19 citation statements)

References 53 publications

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“…While significant reductions in mortality were demonstrated (28%-60%), these studies did not incorporate propensity analysis techniques into their analysis. One other published study has examined the impact of statins on mortality in older adults discharged from hospital with an AMI that incorporated propensity analysis techniques into the analysis [78]. The authors demonstrated that discharge statin therapy was associated with a decrease in 3-year mortality similar to that found in our study (HR 0.89, 95% CI 0.83-0.96).…”

Section: Discussionsupporting

confidence: 80%

The impact of statins on health services utilization and mortality in older adults discharged from hospital with ischemic heart disease: a cohort study

Cooke

Kirkland

Sketris

et al. 2009

BMC Health Serv Res

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BackgroundCardiovascular disease (CVD) carries a high burden of morbidity and mortality and is associated with significant utilization of health care resources, especially in the elderly. Numerous randomized trials have established the efficacy of cholesterol reduction with statin medications in decreasing mortality in high-risk populations. However, it is not known what the effect of the utilization of these medications in complex older adults has had on mortality and on the utilization of health services, such as physician visits, hospitalizations or cardiovascular procedures.MethodsThis project linked clinical and hospital data from the Improving Cardiovascular Outcomes in Nova Scotia (ICONS) database with administrative data from the Population Health Research Unit to identify all older adults hospitalized with ischemic heart disease between October 15, 1997 and March 31, 2001. All patients were followed for at least one year or until death. Multiple regression techniques, including Cox proportional hazards models and generalized linear models were employed to compare health services utilization and mortality for statin users and non-statin users.ResultsOf 4232 older adults discharged alive from the hospital, 1629 (38%) received a statin after discharge. In multivariate models after adjustment for demographic and clinical characteristics, and propensity score, statins were associated with a 26% reduction in all- cause mortality (hazard ratio (HR) 0.74, 95% confidence interval (CI) 0.63-0.88). However, statin use was not associated with subsequent reductions in health service utilization, including re-hospitalizations (HR, 0.98, 95% CI 0.91-1.06), physician visits (relative risk (RR) 0.97, 95% CI 0.92-1.02) or coronary revascularization procedures (HR 1.15, 95% CI 0.97-1.36).ConclusionAs the utilization of statins continues to grow, their impact on the health care system will continue to be important. Future studies are needed to continue to ensure that those who would realize significant benefit from the medication receive it.

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Section: Discussionsupporting

confidence: 80%

The impact of statins on health services utilization and mortality in older adults discharged from hospital with ischemic heart disease: a cohort study

Cooke

Kirkland

Sketris

et al. 2009

BMC Health Serv Res

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“…1,14 Moreover, the finding of age—statin interaction in observational studies, with reduced protection over the age of 80 years, 15 has raised controversies about the prescription of statins in older patients. The prevalence of statin use in this older population with CAD (41%) is comparable to recent population-based studies conducted on older sample without stratification for the presence of cardiovascular disease 1,16 but much lower than that reported in a study of older people with IHD.…”

Section: Discussionmentioning

confidence: 99%

Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease

Pilotto

Gallina²,

Panza

et al. 2016

The American Journal of Cardiology

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Clinical decision-making for statin treatment in older patients with coronary artery disease (CAD) is under debate, particularly in community-dwelling frail patients at high risk of death. In this retrospective observational study on 2,597 community-dwelling patients aged ≥65 years with a previous hospitalization for CAD, we estimated mortality risk assessed with the Multidimensional Prognostic Index (MPI), based on the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA), used to determine accessibility to homecare services/nursing home admission in 2005 to 2013 in the Padua Health District, Veneto, Italy. Participants were categorized as having mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) baseline mortality risk, and propensity score—adjusted hazard ratios (HRs) of 3-year mortality rate were calculated according to statin treatment in these subgroups. Greater MPI-SVaMA scores were associated with lower rates of statin treatment and higher 3-year mortality rate (MPI-SVaMA-1 = 23.4%; MPI-SVaMA-2 = 39.1%; MPI-SVaMA-3 = 76.2%). After adjusting for propensity score quintiles, statin treatment was associated with lower 3-year mortality risk irrespective of MPI-SVaMA group (HRs [95% confidence intervals] 0.45 [0.37 to 0.55], 0.44 [0.36 to 0.53], and 0.28 [0.21 to 0.39] in MPI-SVaMA-1, -2, and -3 groups, respectively [interaction test p = 0.202]). Subgroup analyses showed that statin treatment was also beneficial irrespective of age (HRs [95% confidence intervals] 0.38 [0.27 to 0.53], 0.45 [0.38 to 0.54], and 0.44 [0.37 to 0.54] in 65 to 74, 75 to 84, and ≥85 year age groups, respectively [interaction test p = 0.597]). In conclusion, in community-dwelling frail older patients with CAD, statin treatment was significantly associated with reduced 3-year mortality rate irrespective of age and multidimensional impairment, although the frailest patients were less likely to be treated with statins.

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“…Secondary prevention guidelines advise lipid lowering therapy ‘regardless of age’ in the majority of older patients with ASCVD unless issues of frailty, comorbidity, and polypharmacy confound management. Despite this mandate, statins are notoriously under-prescribed and under-dosed in this cohort despite their higher risk of recurrent events (6,64,65). Only 24% of patients ≥65yo and 15% of those ≥80 years were receiving a statin at discharge after an MI in one analysis of 23,013 Medicare beneficiaries based on a 1998–2001 dataset (65).…”

Section: Lipidsmentioning

confidence: 95%

“…Despite this mandate, statins are notoriously under-prescribed and under-dosed in this cohort despite their higher risk of recurrent events (6,64,65). Only 24% of patients ≥65yo and 15% of those ≥80 years were receiving a statin at discharge after an MI in one analysis of 23,013 Medicare beneficiaries based on a 1998–2001 dataset (65). Ongoing adherence to lipid lowering drugs is particularly low in older patients (66).…”

Section: Lipidsmentioning

confidence: 95%

Secondary Prevention of Atherosclerotic Cardiovascular Disease in Older Adults

Fleg¹,

Forman²,

Berra³

et al. 2013

Circulation

182

119

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Hydroxymethylglutaryl‐CoA Reductase Inhibitors in Older Persons with Acute Myocardial Infarction: Evidence for an Age–Statin Interaction

Cited by 67 publications

References 53 publications

The impact of statins on health services utilization and mortality in older adults discharged from hospital with ischemic heart disease: a cohort study

The impact of statins on health services utilization and mortality in older adults discharged from hospital with ischemic heart disease: a cohort study

Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease

Secondary Prevention of Atherosclerotic Cardiovascular Disease in Older Adults

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