Catalonia, Spain—Unless older adults over age 75 years have been diagnosed with diabetes, they don’t get much benefit from continuing to take statins for primary prevention, a new study emphasizes.
A report in The BMJ points out that the cholesterol medications are not associated with a reduction in cardiovascular disease (CVD) in that healthy cohort.
For patients with type 2 diabetes, however, use of statins for another 10 years, until age 85 years, appears optimal, according to Spanish researchers.
The study, which was led by the University Institute for Primary Care Research Jordi Gol and Girona Biomedical Research Institute, notes that statin prescriptions to elderly patients have increased in recent decades. Trial evidence is clear, researchers write, in supporting statin treatment for secondary prevention for older patients with existing CVD.
What has been uncertain, they add, is the benefits of statin for older people in good cardiovascular health with or without diabetes. To help clarify the situation, they conducted a retrospective cohort study using the database of the Catalan primary care system in Spain from 2006 to 2015.
Participants were nearly 47,000 people, aged 75 years and older, who had not been diagnosed with atherosclerotic CVD. The study looked at the presence of type 2 diabetes mellitus, as well as whether the patients were new users or nonusers of statins. The cohort was 63% female with a mean age of 77 years, and was followed for 5.6 years.
Results indicate that, in participants without diabetes, the hazard ratios for statin use in patients aged 75 to 84 years were 0.94 (95% confidence interval 0.86-1.04) for atherosclerotic CVD and 0.98 (0.91-1.05) for all-cause mortality. In those aged 85 years and older, hazard ratios were 0.93 (0.82-1.06) and 0.97 (0.90-1.05), respectively, for those endpoints.
In participants with diabetes, meanwhile, the hazard ratio of statin use in those aged 75 to 84 years was 0.76 (0.65-0.89) for atherosclerotic CVD and 0.84 (0.75-0.94) for all-cause mortality versus 0.82 (0.53-1.26) and 1.05 (0.86-1.28) in those aged 85 years and older, respectively.
“In participants older than 74 years without type 2 diabetes, statin treatment was not associated with a reduction in atherosclerotic CVD or in all-cause mortality, even when the incidence of atherosclerotic CVD was statistically significantly higher than the risk thresholds proposed for statin use,” study authors write. “In the presence of diabetes, statin use was statistically significantly associated with reductions in the incidence of atherosclerotic CVD and in all-cause mortality. This effect decreased after age 85 years and disappeared in nonagenarians.”
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A report in The BMJ points out that the cholesterol medications are not associated with a reduction in cardiovascular disease (CVD) in that healthy cohort.
For patients with type 2 diabetes, however, use of statins for another 10 years, until age 85 years, appears optimal, according to Spanish researchers.
The study, which was led by the University Institute for Primary Care Research Jordi Gol and Girona Biomedical Research Institute, notes that statin prescriptions to elderly patients have increased in recent decades. Trial evidence is clear, researchers write, in supporting statin treatment for secondary prevention for older patients with existing CVD.
What has been uncertain, they add, is the benefits of statin for older people in good cardiovascular health with or without diabetes. To help clarify the situation, they conducted a retrospective cohort study using the database of the Catalan primary care system in Spain from 2006 to 2015.
Participants were nearly 47,000 people, aged 75 years and older, who had not been diagnosed with atherosclerotic CVD. The study looked at the presence of type 2 diabetes mellitus, as well as whether the patients were new users or nonusers of statins. The cohort was 63% female with a mean age of 77 years, and was followed for 5.6 years.
Results indicate that, in participants without diabetes, the hazard ratios for statin use in patients aged 75 to 84 years were 0.94 (95% confidence interval 0.86-1.04) for atherosclerotic CVD and 0.98 (0.91-1.05) for all-cause mortality. In those aged 85 years and older, hazard ratios were 0.93 (0.82-1.06) and 0.97 (0.90-1.05), respectively, for those endpoints.
In participants with diabetes, meanwhile, the hazard ratio of statin use in those aged 75 to 84 years was 0.76 (0.65-0.89) for atherosclerotic CVD and 0.84 (0.75-0.94) for all-cause mortality versus 0.82 (0.53-1.26) and 1.05 (0.86-1.28) in those aged 85 years and older, respectively.
“In participants older than 74 years without type 2 diabetes, statin treatment was not associated with a reduction in atherosclerotic CVD or in all-cause mortality, even when the incidence of atherosclerotic CVD was statistically significantly higher than the risk thresholds proposed for statin use,” study authors write. “In the presence of diabetes, statin use was statistically significantly associated with reductions in the incidence of atherosclerotic CVD and in all-cause mortality. This effect decreased after age 85 years and disappeared in nonagenarians.”
« Click here to return to Weekly News Update.
