Use of statins in the elderly according to age and indication—a cross-sectional population-based register study

Abstract

Purpose To investigate statin use in the elderly by age (≥ 80 vs. 65-79 years) in relation to established indications. Methods A population-based cohort, including data from four registers, encompassing inhabitants in Region Västra Götaland, Sweden, was used. Statin users were defined as those filling statin prescriptions ≥ 75% of the year 2010. Primary care and hospital diagnoses in 2005-2010 regarding ischemic heart disease, stroke, transient ischemic attacks, and diabetes were considered established indications. Results A total of 278,205 individuals were analyzed. In individuals aged ≥ 80 and 65-79 years (n = 81,885 and n = 196,320, respectively), 17% (95% confidence interval 17%; 18%) and 23% (23%; 23%) respectively, were statin users. Among the statin users, 74% (73%; 74%) of those aged ≥ 80 and 60% (59%; 60%) of those aged 65-79 years had ≥ 1 established indication. Conversely, of those with ≥ 1 established indication, 30% (30%; 31%) and 53% (52%; 53%) were on statins in the respective age groups. Logistic regression revealed that age, nursing home residence, and multi-dose drug dispensing were the most prominent negative predictors for statin use; adjusted odds ratios (95% confidence interval): 0.45 (0.44; 0.46), 0.39 (0.36; 0.42), and 0.47 (0.44; 0.49), respectively. Conclusions In the oldest old (≥ 80 years), statin users were fewer and had more often an established indication, suggesting that physicians extrapolate scientific evidence for beneficial effects in younger age groups to the oldest, but require a more solid ground for treatment. As the oldest old, nursing home residents, and those with multi-dose drug-dispensing were statin users to a lesser extent, physicians may often refrain from treatment in those with lower life expectancy, either due to age or to severely reduced health status. In both age groups, our results however also indicate some over-as well as undertreatment.

Prevalence and initiation of statin therapy in the oldest old—a longitudinal population-based study

“…Furthermore, almost nine in ten of these patients had an underlying established indication for statin treatment. These results are in line with our previous study, where old age was positively associated with the presence of an established indication, suggesting that this age group is more often prescribed statins for secondary prevention [10].…”

“…In a previous population-based study on statin use in older people according to age and indication [ 10 ], we found a relatively high prevalence of statin users. That is, 17% of all individuals ≥ 80 years of age were on statins in 2010, compared with 23% in the age group 65–80 years.…”

“…Furthermore, it may be regarded as a limitation that we did not differentiate our results between secondary prevention (ischemic heart disease and/or cerebrovascular disease) and primary prevention. Indeed, statin treatment for secondary prevention is reportedly less common in those 80 years or older compared with younger olds [ 10 ].…”

Prevention and Treatment of Acute Stroke in the Nonagenarians and Beyond: Medical and Ethical Issues

“…The largest observational study to date including 8307 patients older than 85 years has concluded that statin use was not associated with any benefit in incident stroke or death in these patients (25). Data from clinical practice suggest that the oldest old patients are nevertheless prescribed statin therapy, albeit less frequently (26).…”

Medication Safety in Municipal Health and Care Services

“…& Fastbom, 2008;Lea et al, 2019;Lönnbro & Wallerstedt, 2017;Sjoberg et al, 2011). However, one study found that MDD was associated with a lower probability of statin use, and one found that MDD users were less exposed to drug-drug interactions and long-acting benzodiazepines than patients with ordinary prescribing(Johnell & Fastbom, 2008;Sundvall et al, 2019) …”