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J Am Geriatr Soc. 2017 Nov;65(11):2362-2368. doi: 10.1111/jgs.14993. Epub 2017 Sep 11.

Statins for Primary Prevention of Cardiovascular Events and Mortality in Older Men.

Author information

1
Geriatric Research, Education, and Clinical Center (GRECC) and Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA.
2
Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
3
Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Abstract

BACKGROUND/OBJECTIVES:

We sought to determine whether statin use for primary prevention is associated with a lower risk of cardiovascular events or mortality in older men.

DESIGN:

Prospective cohort study.

SETTING:

Physicians' Health Study participants.

PARTICIPANTS:

7,213 male physicians ≥70 years without a history of cardiovascular disease (CVD).

MEASUREMENTS:

Multivariable propensity score for statin use with greedy matching (1:1) to minimize confounding by indication.

RESULTS:

Median baseline age was 77 (70-102), median follow-up was 7 years. Non-users were matched to 1,130 statin users. Statin use was associated with an 18% lower risk of all-cause mortality, HR 0.82 (95% CI 0.69-0.98) and non-significant lower risk of CVD events, HR 0.86 (95% CI 0.70-1.06) and stroke, HR 0.70 (95% CI 0.45-1.09). In subgroup analyses, results did not change according to age group at baseline (70-76 or >76 years) or functional status. There was a suggestion that those >76 at baseline did not benefit from statins for mortality, HR 1.14 (95% CI 0.89-1.47), compared to those 70-76 at baseline, HR 0.83 (95% CI 0.61-1.11); however the CIs overlap between the two groups, suggesting no difference. Statin users with elevated total cholesterol had fewer major CVD events than non-users, HR 0.68 (95% CI 0.50-0.94) and HR 1.43 (95% CI 0.99-2.07)), respectively.

CONCLUSIONS:

Statin use was associated with a significant lower risk of mortality in older male physicians ≥70 and a nonsignificant lower risk of CVD events. Results did not change in those who were >76 years at baseline or according to functional status. There was a suggestion that those with elevated total cholesterol may benefit. Further work is needed to determine which older individuals will benefit from statins as primary prevention.

KEYWORDS:

aging; cardiovascular disease; prevention; statins

PMID:
28892121
PMCID:
PMC5681374
[Available on 2018-11-01]
DOI:
10.1111/jgs.14993
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