How Effective Are Statins for Patients 75 and Older?

Current therapy recommendations may need adjustment, according to new study on statins for patients 75 and older.

Cardiovascular disease (CVD) is the leading cause of death. Incidence and mortality rates from CVD are three times higher among older adults (>74 years). Current research recommends statins for secondary prevention of CVD in those over 75 years. There is little to no research on statin use as primary prevention in people older than 74, however, current guidelines recommend almost all persons age 75 and older use statins. People with diabetes have a high risk of developing CVD and yet there are few studies showing the benefit of statin use in people with diabetes who are age 75 and older.

A study was done in Spain to determine if there is a benefit of taking statins over the age of 74 in both people with and without diabetes. It was a retrospective cohort study that used data from the Spanish Information system. Data from 46,864 people over 75 years old with no CVD history was analyzed. Of those included in the study, 7,502 were taking a stain and 7,880 people had type 2 diabetes. Median follow up was 7.7 years.

Results showed in participants without diabetes, the hazard ratios for statin use were 0.94 (95% confidence interval 0.86 to 1.04) for atherosclerotic CVD and 0.98 (0.91 to 1.05) for all-cause mortality in 75–84 yr/olds. No benefit was observed for participants without diabetes age 85 years and older with a 0.93 (0.82 to 1.06) for atherosclerotic CVD and 0.97 (0.90 to 1.05) for all-cause mortality. In persons with diabetes age 74–84, the hazard ratios for statin use were 0.76 (0.65 to 0.89) for atherosclerotic CVD and 0.84 (0.75 to 0.94) for all-cause mortality. The number needed to treat was 164 for atherosclerotic CVD and 306 for all-cause mortality. The hazard ratios were 0.82 (0.53 to 1.26) for atherosclerotic CVD and 1.05 (0.86 to 1.28) for all-cause mortality in people with diabetes who are age 85 and older.

This study found little benefit between statin use and the lowering of atherosclerotic CVD events or all-cause mortality in patients considered elderly who do not have diabetes. In participants with diabetes, statins significantly reduced the incidence of atherosclerotic CVD by 24% and all-cause mortality by 16% in those age 75–84 years. However, no benefit was observed in people with type 2 diabetes who are age 85 and older. Current recommendations suggest statin use in the very old, but this study does not find that to be useful. It did find statins to be beneficial to a specific population, i.e., people with type 2 diabetes who are 75–84 years of age. Statin use had a protective factor in this group against atherosclerotic CVD and for all-cause mortality, but that effect seemed to wear off at the age of 85 and dropped significantly at age 92 or older. This loss of effectiveness could be due to the aging process and at that age is a main contributor to death.

Practice Pearls:

• Statin use in type 2 diabetes reduces atherosclerotic CVD risk in patients age 75–84 years.
• According to this study, there was no benefit from statin therapy for primary prevention of atherosclerotic CVD or all-cause mortality in people without diabetes who are over the age of 75.
• Current statin therapy recommendations need to be adjusted for patients who are elderly since no benefit was seen with its use in people with or without diabetes and over 85 years of age.

References:

Rafel Ramos, Marc Comas-Cufí, Ruth Martí-Lluch, Elisabeth Balló, Anna Ponjoan, Lia Alves-Cabratosa, Jordi Blanch, Jaume Marrugat, Roberto Elosua, María Grau, Marc Elosua-Bayes,Luis García-Ortiz, Maria Garcia-Gil.

Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type  2 diabetes: retrospective cohort study. BMJ (2018);362:k3359; doi: 10.1136/bmj.k3359