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

• Published in: The American journal of medicine Vol. 132; no. 6; pp. 740 - 748.e7
• Main Authors: Bezin, Julien, Moore, Nicholas, Mansiaux, Yohann, Steg, Philippe Gabriel, Pariente, Antoine
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2019; Elsevier [Commercial Publisher]
• Subjects: Aged; Aged, 80 and over; Cardiovascular Diseases - prevention & control; Cardiovascular risk; Cohort Studies; Comparative effectiveness research; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Life Sciences; Male; Pharmacoepidemiology; Population-wide database; Risk Factors; Santé publique et épidémiologie; Statin; Comparative effectiveness research; Pharmacoepidemiology; Population-wide database; Statin; Cardiovascular risk; PharmacoEpi-Drugs
• ISSN: 0002-9343; 1555-7162; 1555-7162
• DOI: 10.1016/j.amjmed.2018.12.032

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