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Decreased Risk of Death Tied to the Use of Statins

Jul 21, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Olivia Shenouda, Fourth Year Doctor of Pharmacy Candidate, Florida A&M University

The use of statins in veterans 75 years or older was associated with an overall reduced risk of morbidity and mortality.

Cardiovascular disease and complications are more life-threatening in older patients than younger populations or middle-aged patients. Risks include long term disability or even risk of death. That is why primary and secondary prevention, using lifestyle modification and statins, are gaining increasing importance among physicians.

This study followed 300,000 U.S. veterans aged 75 and older for approximately seven years. All were free of atherosclerotic cardiovascular disease at the start of the study. Statins were shown to reduce the risk of atherosclerotic disease, especially in patients older than 75, by 25%. This makes statins an excellent choice for early prophylaxis in the elderly to avoid atherosclerotic disease. High-intensity statins offer a more significant decrease in LDLs in a shorter time; they are associated with higher chances of side effects, including rhabdomyolysis and muscle cramps.

Statins were also shown to reduce the risk of death by cardiovascular diseases, such as myocardial infarction and stroke. Myocardial infarction and stroke are some of the primary disorders caused by atherosclerosis, which is the hardening and the blockade of the arteries that lead to death or functional incapacity. The overall risk was reduced by 20%.

The study was done to evaluate the importance of statins for the treatment and prevention of atherosclerotic disease and cardiovascular complications in veterans over 75 years old. One of this study’s advantages is that the follow-up time of seven years was sufficient to monitor patients for long term side effects or adverse events. At the end of the study, they were all free of atherosclerosis and atherosclerotic risk. The median age of the study was 81 years, mostly white males. That is a disadvantage of the study because it was not inclusive of all races and genders. The study did not follow the “Gold standard” of trials, which is randomized controlled trials, which took away from the reliability of the results.

The study had a primary outcome that was all-cause mortality. The secondary outcome was the composite risk of myocardial infarction, ischemic stroke, and revascularization with coronary interventions. Lower death rates were not only linked to cardiovascular disease but also other conditions such as dementia. Patients with such chronic diseases have been excluded from other studies.

The hazard was significantly lower in the group of patients taking statins than in patients not taking statins. After adjustment for propensity scores, the hazard ratio for statin users was 0.75 for all-cause mortality and 0.80 for cardiovascular mortality, compared with non-users, but the study’s size was important to gain statistically significant information on elderly populations. During the study’s slotted time, the most commonly prescribed statin was simvastatin, which is a low or moderate-intensity statin, but currently, higher-intensity statins are more frequently prescribed by physicians due to the ever-increasing risk of cardiovascular disease. Cardiovascular risk was also shown in younger middle-aged patients. While statins are well tolerated and have a low profile of side effects, many patients reported painful aches and cramps due to a condition called rhabdomyolysis, which could lead some patients to stop adhering to the drug. The study mentioned today did not evaluate the adherence of patients taking or discontinuing statin use.

The study concluded that statin use was associated with lower risk of cardiovascular mortality. Further trials and research are needed to determine the role of statin therapy for elderly patients. Due to the lack of safety studies, the research will require more investigation. However, this study was pointed towards an older population. A study population that includes a more significant number of women and more diverse ethnicities is needed to evaluate the risk reduction better

Practice Pearls:

  • Statins were shown to decrease the risk of morbidity and mortality in patients 75 years or older.
  • Higher intensity statins are more commonly prescribed than lower or medium intensity.
  • Increasing LDLs are a considerable risk to atherosclerotic disease.

 

Kohli, Dr. Kamal Kant. “Statins Reduce Death Risk by 25% in Elderly above 75 Years : AMA Study.” Medical Dialogues, Medical Dialogues, 8 July 2020, medical dialogues.in/medicine/news/statins-reduce-death-risk-by-25in-elderly-above-75 -years-JAMA-study-67405.

 

Olivia Shenouda, Fourth Year Doctor of Pharmacy Candidate, Florida A&M University

 

See more about statins and mortality.