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Am J Med. 2019 Jun;132(6):740-748.e7. doi: 10.1016/j.amjmed.2018.12.032. Epub 2019 Jan 18.

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

Author information

1
University Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Unité Mixte de Recherche (UMR) 1219, Bordeaux, France. Electronic address: julien.bezin@u-bordeaux.fr.
2
University Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Unité Mixte de Recherche (UMR) 1219, Bordeaux, France; Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France; Bordeaux PharmacoEpi, INSERM CIC 1401, Bordeaux, France.
3
University Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Unité Mixte de Recherche (UMR) 1219, Bordeaux, France.
4
FACT (French Alliance for Cardiovascular Clinical Trials), Département Hospitalo-Universitaire (DHU) Fibrose Inflammation Remodelage (FIRE), University Paris Diderot, Assistance Publique - Hôpitaux de Paris (AP-HP), INSERM U-1148, Paris, France; National Heart and Lung Institute (NHLI), Institute of Cardiovascular Medicine and Science (ICMS), Royal Brompton Hospital, Imperial College, London, United Kingdom.
5
University Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Unité Mixte de Recherche (UMR) 1219, Bordeaux, France; Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France.

Abstract

OBJECTIVES:

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

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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.

KEYWORDS:

Cardiovascular risk; Comparative effectiveness research; Pharmacoepidemiology; Population-wide database; Statin

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