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Real-Life Benefits of Statins for Cardiovascular Prevention in Elderly Subjects: A Population-Based Cohort Study

  • Julien Bezin
    Correspondence
    Requests for reprints should be addressed to Julien Bezin, PharmD, PhD, Pharmacoepidemiology and Population Impact of Drugs, Bordeaux Population Health Research Center, University of Bordeaux, Case 121, 146 rue Léo Saignat, F-33076 Bordeaux cedex, France.
    Affiliations
    University Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Unité Mixte de Recherche (UMR) 1219, Bordeaux, France
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  • Nicholas Moore
    Affiliations
    University Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Unité Mixte de Recherche (UMR) 1219, Bordeaux, France

    Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France

    Bordeaux PharmacoEpi, INSERM CIC 1401, Bordeaux, France
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  • Yohann Mansiaux
    Affiliations
    University Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Unité Mixte de Recherche (UMR) 1219, Bordeaux, France
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  • Philippe Gabriel Steg
    Affiliations
    FACT (French Alliance for Cardiovascular Clinical Trials), Département Hospitalo-Universitaire (DHU) Fibrose Inflammation Remodelage (FIRE), University Paris Diderot, Assistance Publique – Hôpitaux de Paris (AP-HP), INSERM U-1148, Paris, France

    National Heart and Lung Institute (NHLI), Institute of Cardiovascular Medicine and Science (ICMS), Royal Brompton Hospital, Imperial College, London, United Kingdom
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  • Antoine Pariente
    Affiliations
    University Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Unité Mixte de Recherche (UMR) 1219, Bordeaux, France

    Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
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Published:January 17, 2019DOI:https://doi.org/10.1016/j.amjmed.2018.12.032

      Abstract

      Objectives

      The benefits of initiating statins in the elderly remains debated. We evaluated the effects of initiating statins in the elderly, according to cardiovascular risk.

      Methods

      This population-based cohort study used data of the representative sample of the French health care system database for the 2008-2015 period. New users of statins, aged 75 years and older, were dynamically included in the cohort and matched 1:1 to statin nonusers on age, sex, numbers of different drugs dispensed and medical consultations, and cardiovascular history. Patients were classified into 3 cardiovascular risk groups: secondary prevention (history of coronary heart disease), primary prevention with modifiable risk factors (diabetes or cardiovascular medications), and primary prevention without modifiable risk factors (none of the above). Effect of cumulative use of statins on occurrence of acute coronary syndrome or all-cause death was analyzed by using multivariable time-dependent Cox models stratified on cardiovascular risk at inclusion.

      Results

      Among the 7284 patients included, median follow-up was 4.7 years. Cumulative use of statins was associated with a lower risk of outcomes in the primary prevention with modifiable risk factors group (adjusted hazard ratio 0.93 per year of use; 95% confidence interval, 0.89-0.96; P < .01) and in the secondary prevention group (0.75; 0.63-0.90; P < .01), but not in the primary prevention without modifiable risk factors group (1.01; 0.86-1.18; P = .92).

      Conclusions

      Statin treatment was not associated with a reduction in acute coronary syndrome or all-cause death in elderly without modifiable cardiovascular risk factor treated in primary prevention.

      Keywords

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