There is little consensus on whether or when to use statins for primary CVD prevention in older patients, but a new study in the Annals of Internal Medicine provides compelling evidence for expanding statin use in this population.
The researchers analyzed matched pairs of statin and non-statin users without pre-existing CVD in the 60-74 (73,427 pairs), 75-84 (21,340 pairs), and 85+ (2,695 pairs) age groups using EHR data from the Hong Kong Health Authority.
Over five years, they found that statin use reduced:
- Composite CVD events (MI, heart failure, or stroke) by 11%, 6%, and 15% in the three age groups.
- Composite CVD events by 23%, 21%, and 35%, among patients who adhered to their statin treatments.
- CVD event risks by 1.2% within the 75-84 age group, and 4.4% in the 85+ age group.
- CVD event risks by 5% and 12.5%, among patients who adhered to their statin treatments.
Statins also didn’t significantly increase the patients’ myopathy and liver dysfunction risks, addressing one of the main arguments against initiating statins in older patients
In other words, this data suggests that preventative statin use has significant benefits among older patients, without significant risks.
- However, observers found plenty of opportunities to poke holes in this analysis, given that it wasn’t an RCT, while others emphasized that older patients’ statin decisions should still be individualized.
The Takeaway
Few would argue against statins’ cardiovascular benefits, and most would agree that cardiovascular burdens are increasing in older populations, but many older people who might qualify for preventive statins still aren’t taking the drugs. This study might not be an RCT, but its results certainly support steering more of those at-risk older patients towards primary prevention statin therapy.
