Examine after research has proven that statins can stop coronary heart assaults, strokes and demise in middle-aged adults. However in 28 main medical trials of statins, solely 2 % of members have been 75 years or older. Which means that although older adults are at better danger of coronary heart illness and demise, there’s scant information on whether or not statins needs to be prescribed for them.
A brand new research sheds mild on the position statins might play for older adults who haven’t but skilled a coronary heart assault, stroke or different cardiovascular occasion.
Of their retrospective evaluation, a crew of investigators from Harvard-affiliated Brigham and Girls’s Hospital and the VA Boston Healthcare System leverages nationwide information from the U.S. Veterans Well being Administration Providers and Facilities for Medicare & Medicaid Providers discovered that the chance of dying from any trigger was decrease by 25 % amongst veterans who had been utilizing statins in comparison with those that weren’t handled with statins. The chance of dying from a cardiovascular occasion, comparable to a coronary heart assault or stroke, was decrease by 20 %. The crew’s outcomes are printed in JAMA.
“Primarily based on these information, age shouldn’t be a cause to not prescribe statins,” stated lead and corresponding writer Ariela Orkaby, a doctor scientist on the VA Boston Well being Care System and within the Division of Growing older on the Brigham. “Statins are generally studied and prescribed for middle-aged adults however understudied in individuals over age 75. One of the outstanding issues about our outcomes is that we discovered the good thing about statins held true no matter whether or not an individual was older or youthful or had a situation comparable to dementia.”
Orkaby and colleagues checked out information on veterans who used VA companies between 2002 and 2012, had been 75 years or older, and had not beforehand had a coronary heart assault, stroke or different cardiovascular occasion. Of the greater than 300,000 eligible veterans, the crew recognized greater than 57,000 who started taking statins throughout this time. Utilizing propensity scoring, the authors in contrast people who started taking statins to those that had the identical probability of being prescribed a statin based mostly on medical traits however didn’t obtain a prescription for the drug.
Total, taking statins was considerably related to decrease danger of demise from a cardiovascular occasion or demise from any trigger. And the advantages remained for veterans at superior age, together with those that had been 90 years or older. Decrease demise charges prolonged to these with different situations comparable to dementia — people who’ve been excluded from earlier research. In secondary analyses, the crew discovered that beginning a statin was additionally considerably related to a decrease danger of cardiovascular occasions comparable to coronary heart assaults and strokes. Orkaby notes that it was notably intriguing to see a marked decline in price of strokes among the many research’s Black members.
“There are lots of fascinating results in observe up on,” stated Orkaby, “however it’s vital to take into account that this isn’t a randomized, medical trial. As a substitute, it’s a retrospective evaluation utilizing actual world information that helps us discover the place the reality lies.”
The research centered solely on veterans, a predominantly white and male inhabitants, which can restrict its generalizability, however the research’s measurement made it doable to glean statistically significant data on underrepresented teams. Throughout the research’s timeframe, essentially the most generally prescribed statin was simvastatin, however at present, higher-dose and higher-intensity statins have grow to be extra often prescribed. Whereas statins are typically nicely tolerated, many individuals report aches and pains as a facet impact, which can lead some to cease taking the drug. The present research didn’t consider whether or not sufferers discontinued statin use.
Two randomized, medical trials of statins amongst older adults are actually underway with outcomes from one of many research anticipated later this yr. Orkaby and colleagues plan to observe up on their research by exploring the results of statin dosing and analyzing outcomes for sub-populations included of their evaluation.
This analysis was supported by the VA (CSR&D CDA-2 award IK2-CX001800), Nationwide Institute on Growing older (R03-AG060169), and VA Benefit Award I01 CX001025. Assist for VA/Facilities for Medicare & Medicaid Providers information is offered by the Division of Veterans Affairs, VA Well being Providers Analysis and Growth Service, VA Data Useful resource Middle (venture numbers SDR 02-237 and 98-004). Coauthor Luc Djousse, reported receiving grants from Merck.