Statins for Primary Prevention of Cardiovascular Events and Mortality in Older Men

Abstract

Background/Objectives We sought to determine whether statin use for primary prevention is associated with a reduction in cardiovascular events or mortality in older men. Design Prospective cohort study. Setting Physicians’ Health Study participants. Participants 7,213 male physicians ≥70 years without a history of cardiovascular disease (CVD). Measurements Multivariable propensity score for statin use with greedy matching (1:1) to minimize confounding by indication. Results Median baseline age was 77 (70–102), median follow-up was 7 years. Non-users were matched to 1,130 statin users. Statin use was associated with an 18% lower risk of all-cause mortality, HR 0.82 [95%CI 0.69–0.98] and non-significant lower risk of CVD events, HR 0.86 [95%CI 0.70–1.06] and stroke, HR 0.70 [95%CI 0.45–1.09]. In subgroup analyses, results did not change according to age group at baseline (70–76 or >76 years) or functional status. There was a suggestion that those >76 at baseline did not benefit from statins for mortality, HR 1.14 [95%CI 0.89–1.47], compared to those 70–76 at baseline, HR 0.83 [95%CI 0.61–1.11]; however the CIs overlap between the two groups, suggesting no difference. Statin users with elevated total cholesterol had fewer major CVD events than non-users. HR were 0.68 [95%CI 0.50–0.94] and HR 1.43 [95%CI 0.99–2.07], respectively. Conclusions Statin use was associated with a significant lower risk of mortality in older male physicians ≥70 and a nonsignificant lower risk of CVD events. Results did not change in those who were >76 years at baseline or according to functional status. There was a suggestion that those with elevated total cholesterol may benefit. Further work is needed to determine which older individuals will benefit from statins as primary prevention.

Management of high cholesterol levels in older people

“…Large meta‐analyses have underlined the effects of statins in primary and secondary prevention in older patients, possibly with a slightly lesser significance over the age of 75 years …”

“…Large meta-analyses have underlined the effects of statins in primary and secondary prevention in older patients, [57][58][59] possibly with a slightly lesser significance over the age of 75 years. 27 The protective effect of statin treatment versus stroke was also investigated.…”

Statin Use Over 65 Years of Age and All‐Cause Mortality: A 10‐Year Follow‐Up of 19 518 People

“…Prospective evidence supporting the efficacy of statins for primary prevention among older adults is scarce; recent observational studies attempted to address this gap with conflicting results. In a cohort of 1130 American male physicians who used statins, there were fewer deaths (HR = .82) and cardiovascular events (HR = .86) over a median follow‐up of 7.1 years compared with a matched cohort of nonusers . There was no evidence for benefit among those older than 76 years, but this conclusion was based on few participants and did not reach statistical significance.…”

Challenges of a Statin Trial in Older People

“…This might lead to unnecessary discontinuation of ongoing statin treatments solely because of age. However, starting a statin before old age robustly prevents cardiovascular events, and accordingly, several observational studies show that older statin users do have a better prognosis, even irrespective of their functional status …”