Statin Use in Older Adults for Primary Cardiovascular Disease Prevention Across a Spectrum of Cardiovascular Risk

Abstract

BACKGROUND: There remains uncertainty regarding optimal primary atherosclerotic cardiovascular disease (ASCVD) prevention practices for older adults. OBJECTIVE: To assess statin treatment patterns and incident ASCVD among older patients for primary prevention across the spectrum of ASCVD risk. DESIGN: Retrospective cohort study of participants without ASCVD aged 65-79 years. Patients were stratified by age (65-69, 70-75, > 75 years) and 10-year ASCVD risk category (low/borderline, intermediate, high) based on the Pooled Cohort Equations. Multivariable logistic regressions were used to identify predictors of moderate-or high-intensity statin prescriptions. Cox proportional models were used to estimate hazard ratios (HRs) for incident ASCVD. PARTICIPANTS: Patients aged 65-79 years without ASCVD from a Northern California health system. MAIN MEASURES: Statin prescriptions and incident ASCVD events. KEY RESULTS: There were 54,066 patients, with 10,288 (19%) aged > 75 years and 57% women. Compared with younger groups, adults > 75 years were less likely to be prescribed moderate-or high-intensity statin prescriptions across ASCVD risk groups (all p < 0.001); this persisted after multivariable adjustment including for ASCVD risk (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.74-0.86). Adults > 75 years were more likely to experience incident ASCVD (HR 1.42, 95% CI 1.23-1.63). Women (OR 0.85, 95% CI 0.81-0.89) and underweight older adults (OR 0.45, 95% CI 0.33-0.61) were also less likely to receive moderate-or high-intensity statins. CONCLUSIONS: Among older adults aged 65-79 years without prior ASCVD, those > 75 years of age were less likely to receive moderate-or high-intensity statins regardless of ASCVD risk compared with their younger counterparts, while experiencing more incident ASCVD. Efforts are warranted to study the reasons for age-based differences in statin use in older adults, particularly those at highest ASCVD risk.

Statin utilization and cardiovascular outcomes in a real-world primary prevention cohort of older adults

“…Our study extends prior work by Sarraju et al, evaluated statin use for primary prevention in individuals 65–79 years of age and showed that older adults >75 years were less likely to receive a moderate or high intensity statin regardless of ASCVD risk compared to those who were <75 years [16] . Similar to our result these patients had a higher incidence of ASCVD events – followed up to only 1 year.…”

“…This is further evidence that statin utilization in older adults is a missed opportunity that has potential for improvement. Currently there is limited comparative data on statin initiation in older adults however, trends of the limited data support that it is possible that the rates are low as we have shown given various practice model sites across the healthcare system [16] .…”

Lipid-Targeted Atherosclerotic Risk Reduction in Older Adults: A Review

“…Thus, the PCE calculation approach does not allow for a nuanced risk assessment of older adults, for whom an individualized consideration of comorbid conditions, frailty, and reduced life expectancy is paramount. Uncertainty in risk assessment often leads to fewer prescriptions for statin therapy in adults >75 years of age, likely causing some to be deprived of potentially marked benefits [72].…”