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Statins ineffective for primary prevention in patients 75 years or older without diabetes
Clinical Question
In older people without a history of cardiovascular disease, is statin treatment associated with better outcomes?
Bottom line
In this retrospective study, statin treatment in patients 75 years or older without pre-existing cardiovascular disease (CVD) did not change the likelihood of developing CVD or reduce any-cause mortality. However, patients aged 75 to 84 years with diabetes benefitted from treatment. These results support the results from the ALLHAT study. 2b
Reference
Study design: Cohort (retrospective)
Funding: Government
Setting: Population-based
Synopsis
This study enrolled 46,864 patients 75 years or older with no cardiovascular disease from a population database in Spain. The patients had an average age of 76 years (63% were women) and were followed up for an average of 5.6 years. Of these, 6550 patients began statin treatment in the 18 months before the start of the study. In participants without diabetes there was no difference in the onset of CVD (hazard ratio [HR] 0.94; 95% CI 0.86 - 1.04) or the rate of mortality due to any reason (HR 0.98; 0.91 - 1.05). In patients 85 years or older, there also was no reduction in the likelihood of CVD (HR 0.93; 0.82 - 1.06) or all-cause mortality (HR 0.97; 0.90 - 1.05), However, in patients with diabetes who were between the ages of 75 and 84 years, the likelihood of developing CVD was reduced (HR 0.76; 0.65 - 0.89). All-cause mortality was decreased over an average 5.6 years, with one additional person alive for every 16 persons treated with a statin (number needed to treat [NNT] = 15.63; 9.5 - 49.6). The difference was not significant for any patients 85 years or older.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
This information would help in elderly patients who are on multiple medications where it would make care less confusing and risky if they could drop a medication which is not helping anyway.
Helpful POEM for me. I am an ED doc who weirdly also does housecalls. I have noticed that almost all housecall patients I see over the age of 65 are on statins. It can't be true that all of these patients need these drugs. Not that I intend to question the judgement of the patient's FP however I am commonly asked about the need for statins and now I at least have a more refined message to give to patients over 75.
Excellent
good poem
The Allhat study link does not open.
Pharma & Bayer are quick to ally their products with primary prevention in consumer advertising. Assuming 5% diabetes incidence We see that more than 99% of this high aged group did not stand to benefit from any statin for primary prevention. I reset my case
une raison additionnelle pour supporter de ne pas traiter pt de cette age et justifie donc de ne pas faire les tests pour les lipids à cette age.
Statins
No indication whether or not statin treated patients had high or normal cholesterol. Separating these groups might have shown a difference