Advertisement

Statin Therapy for Primary Prevention in the Elderly and Its Association with New-Onset Diabetes, Cardiovascular Events, and All-Cause Mortality

Published:November 17, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.09.058

      Abstract

      Purpose

      This study assessed associations of the use of statins for primary prevention with cardiovascular outcomes among adults ages ≥70 years.

      Methods

      In a retrospective population-based cohort study, new users of statins without cardiovascular disease or diabetes mellitus were stratified by ages ≥70 years and <70 years. Using a time-dependent approach, adherence to statins was evaluated according to the proportion of days covered: <25%, 25%-50%, 50%-75%, and ≥75%. We assessed associations of statin therapy with increased risk of new-onset diabetes mellitus and with decreased risks of major adverse cardiovascular events and all-cause mortality.

      Results

      Of 42,767 new users of statins, 5970 (14%) were ages ≥70 years. The incident rates of major adverse cardiovascular events, all-cause mortality, and new-onset diabetes mellitus in the highest to lowest proportion of days covered categories were 16.9%, 16.7%, and 9.4% and 6.3%, 1.7%, and 9.4%, respectively. For the older group, the adjusted hazard ratios of major adverse cardiovascular events and mortality were significantly decreased for the highest adherence group (proportion of days covered ≥75%): 0.71 (0.57-0.88) and 0.68 (0.54-0.84), respectively. The respective hazard ratios were less favorable for the younger group: 0.80 (0.68-0.93) and 0.74 (0.58-1.03). The risk of new-onset diabetes mellitus was increased for the younger but not the older group.

      Conclusions

      Statin use for primary prevention was associated with cardiovascular benefit in adults ages ≥70 years without a significant risk for the development of diabetes. These data may support the use of statin therapy for primary prevention in the elderly.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Taylor F
        • Huffman MD
        • Macedo AF
        • et al.
        Statins for the primary prevention of cardiovascular disease.
        Cochrane Database Syst Rev. 2013; 2013CD004816
        • Collins R
        • Reith C
        • Emberson J
        • et al.
        Interpretation of the evidence for the efficacy and safety of statin therapy.
        Lancet. 2016; 388: 2532-2561
        • Afilalo J
        • Duque G
        • Steele R
        • Jukema JW
        • de Craen AJ
        • Eisenberg MJ
        Statins for secondary prevention in elderly patients: a hierarchical Bayesian meta-analysis.
        J Am Coll Cardiol. 2008; 51: 37-45
        • Sattar N
        • Preiss D
        • Murray HM
        • et al.
        Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials.
        Lancet. 2010; 375: 735-742
        • Navarese EP
        • Buffon A
        • Andreotti F
        • et al.
        Meta-analysis of impact of different types and doses of statins on new-onset diabetes mellitus.
        Am J Cardiol. 2013; 111: 1123-1130
      1. World Health Organization, National Institute of Aging. Global health and aging. Available online: http://www.who.int/ageing/publications/global_health.pdf. Accessed February 8, 2020.

        • Rich MW
        • Chyun DA
        • Skolnick AH
        • et al.
        Knowledge gaps in cardiovascular care of the older adult population: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society.
        J Am Coll Cardiol. 2016; 67: 2419-2440
        • O'Keeffe AG
        • Nazareth I
        • Petersen I
        Time trends in the prescription of statins for the primary prevention of cardiovascular disease in the United Kingdom: a cohort study using The Health Improvement Network primary care data.
        Clin Epidemiol. 2016; 8: 123-132
        • Mortensen MB
        • Falk E
        Primary prevention with statins in the elderly.
        J Am Coll Cardiol. 2018; 71: 85-94
        • Ruiter R
        • Burggraaf J
        • Rissmann R
        Under-representation of elderly in clinical trials: an analysis of the initial approval documents in the Food and Drug Administration database.
        Br J Clin Pharmacol. 2019; 85: 838-844
        • Ponce OJ
        • Larrea-Mantilla L
        • Hemmingsen B
        • et al.
        Lipid-lowering agents in older individuals: a systematic review and meta-analysis of randomized clinical trials.
        J Clin Endocrinol Metab. 2019; 104: 1585-1594
        • Cholesterol Treatment Trialists' Collaboration
        Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials.
        Lancet. 2019; 393: 407-415
        • Jones M
        • Tett S
        • Peeters GM
        • Mishra GD
        • Dobson A
        New-onset diabetes after statin exposure in elderly women: the Australian longitudinal study on women's health.
        Drugs Aging. 2017; 34: 203-209
        • Ramos R
        • Comas-Cufí M
        • Martí-Lluch R
        • et al.
        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
        • Stone NJ
        • Robinson JG
        • Lichtenstein AH
        • et al.
        2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults.
        J Am Coll Cardiol. 2014; 63: 2889-2934
        • National Clinical Guideline Centre
        Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. National Institute for Health and Care Excellence (NICE) clinical guideline, CG181.
        National Institute for Health and Care Excellence (UK), London, UKJuly 2014
        • Anderson TJ
        • Grégoire J
        • Pearson GJ
        • et al.
        2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult.
        Can J Cardiol. 2016; 32: 1263-1282
        • Bibbins-Domingo K
        • Grossman DC
        • Curry SJ
        • et al.
        Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force Recommendation Statement.
        JAMA. 2016; 316: 1997-2007
        • Piepoli MF
        • Hoes AW
        • Agewall S
        • et al.
        2016 European Guidelines on cardiovascular disease prevention in clinical practice.
        Eur Heart J. 2016; 37: 2129-2200
        • Mach F
        • Baigent C
        • Catapano AL
        • et al.
        2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.
        Eur Heart J. 2020; 41: 111-188
        • Thompson W
        • Pottegård A
        • Nielsen JB
        • Haastrup P
        • Jarbøl DE
        How common is statin use in the oldest old?.
        Drugs Aging. 2018; 35: 679-686
        • Odden MC
        • Pletcher MJ
        • Coxson PG
        • et al.
        Cost effectiveness and population impact of statins for primary prevention in adults aged 75 years or older in the United States.
        Ann Intern Med. 2015; 162: 533-541
        • Zoungas S
        • Curtis A
        • Tonkin A
        • McNeil J
        Statins in the elderly: an answered question?.
        Curr Opin Cardiol. 2014; 29: 372-380
        • Ray WA
        Evaluating medication effects outside of clinical trials: new-user designs.
        Am J Epidemiol. 2003; 158: 915-920
        • Central Bureau of Statistics
        Characterization and Classification of Geographical Units by the Socio-Economic Level of the Population, 2013.
        Israel Central Bureau of Statistics, Jerusalem2017 (Available at:)
        • Karpati T
        • Cohen-Stavi CJ
        • Leibowitz M
        • et al.
        Towards a subsiding diabetes epidemic: trends from a large population-based study in Israel.
        Popul Health Metr. 2014; 12: 32
        • Jun JE
        • Cho IJ
        • Han K
        • et al.
        Statins for primary prevention in adults aged 75 years and older: a nationwide population-based case-control study.
        Atherosclerosis. 2019; 283: 28-34
        • Kim K
        • Lee CJ
        • Shim CY
        • et al.
        Statin and clinical outcomes of primary prevention in individuals aged >75 years: the SCOPE-75 study.
        Atherosclerosis. 2019; 284: 31-36
        • Bezin J
        • Moore N
        • Mansiaux Y
        • Steg PG
        • Pariente A
        Real-life benefits of statins for cardiovascular prevention in elderly subjects: a population-based cohort study.
        Am J Med. 2019; 132: 740-748.e7