Statins and cardiovascular outcomes in elderly and younger patients with coronary artery disease: a post hoc analysis of the GREACE study

Abstract

IntroductionThe effect of cardiovascular disease (CVD) prevention measures aimed at elderly patients requires further evidence. We investigated the effect of statin treatment (targeted to achieve guideline goals) on CVD outcomes in different age groups to determine whether statins are more beneficial in the elderly.Material and methodsThe primary endpoint of this post hoc analysis of the GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study (n = 1,600 patients with established coronary heart disease (CHD), mean follow-up 3 years) was the absolute and relative CVD event (a composite of death, myocardial infarction, revascularization, unstable angina, heart failure and stroke) risk reduction in age quartiles (each n = 200). Patients on “structured care” with atorvastatin (n = 800) followed up by the university clinic and treated to lipid goal were compared with the corresponding quartiles on “usual care” (n = 800) followed up by specialists or general practitioners of the patient's choice outside the hospital.ResultsIn the elderly (mean age 69 ±4 and 70 ±3 years in the “structured” and “usual care”, respectively) the absolute CVD event reduction between “structured” and “usual care” was 16.5% (p < 0.0001), while in the younger patients (mean age 51 ±3 years and 52 ±3 years in the “structured” and “usual care”, respectively) this was 8.5% (p = 0.016); relative risk reduction (RRR) 60% (p < 0.0001) vs. 42% respectively (p = 0.001). The elderly had higher rates of chronic kidney disease and higher uric acid levels, plus an increased prevalence of diabetes, metabolic syndrome and non-alcoholic fatty liver disease. These factors might contribute to the increased CVD risk in older patients.ConclusionsAll age groups benefited from statin treatment, but the elderly on “structured care” had a greater absolute and relative CVD risk reduction than the younger patients when compared with the corresponding patients assigned to “usual care”. These findings suggest that we should not deprive older patients of CVD prevention treatment and lipid target achievement.

GPs’ perspectives on secondary cardiovascular prevention in older age: a focus group study in the Netherlands

“…Although guidelines advocate the use of preventive medication in secondary prevention irrespective of age, 1,2 secondary preventive treatment in older age is often far from optimal. [3][4][5] Looking at the secondary prevention population in the Netherlands, lipid-lowering drugs are prescribed in only 53% of patients aged 75-84 years, and 28% of patients aged ≥85 years. 4 This undertreatment could needlessly increase the CVD burden in older age, as secondary cardiovascular preventive treatment has been shown to be effective even in older age.…”

Lipids, blood pressure and kidney update 2014

“…It is important to emphasize that using "take your time" approach we are able to keep the statin therapy in even 90 % of patients previously suggested as statin intolerant. Taking into account the above definition it does not mean these patients are not statin intolerant (=partial intolerance), however, it is important to emphasize that having and opportunity to use even small dose of statin, we are able to prevent CV risk much more effectively [47][48][49].…”

Clinical research Objectives and methodology of Romanian SEPHAR II Survey. Project for comparing the prevalence and control of cardiovascular risk factors in two east-European countries: Romania and Poland

“…For a research population of 16 833 541 Romanian adults of whom 40.1% are estimated to be hypertensive based on SEPHAR I results [7–9], with a maximum error of ±2.18% at a confidence level of 95%, the minimum required sample size is 1942 individuals.…”