Boston—A recent trend has been to deprescribe preventive medication for older patients. A new study suggests, however, that those actions should be taken with some caution.
Researchers from Brigham and Women’s Hospital and the Veterans Affairs Boston Healthcare System looked at the benefits of statins in veterans aged 75 years and older, and their results raise questions about the benefits of discontinuation.
The report in the Journal of the American Medical Association pointed out that the research was necessary because, even though studies have persistently found that statins can prevent heart attacks, strokes, and death in middle-aged adults, only 2% of participants in 28 major clinical trials of statins were age 75 years or older.
Results indicate that patients who had not yet experienced a heart attack, stroke, or other cardiovascular event had a 25% lower risk of dying from any cause if they were treated with statins compared with those who were not. In addition, the risk of dying from a cardiovascular event, such as a heart attack or stroke, was lower by 20%.
“Based on these data, age is not a reason to not prescribe statins,” said lead and corresponding author Ariela Orkaby, MD, MPH, a physician-scientist at VA Boston Health Care System and in the Division of Aging at the Brigham and Women's Hospital. “Statins are commonly studied and prescribed for middle-aged adults but understudied in people over age 75. One of the most remarkable things about our results is that we found the benefit of statins held true regardless of whether a person was older or younger or had a condition such as dementia.”
Defined as primary outcomes in the retrospective analysis were all-cause and cardiovascular mortality. Secondary outcomes included a composite of atherosclerotic cardiovascular disease (ASCVD) events, including myocardial infarction, ischemic stroke, and revascularization with coronary artery bypass graft surgery or percutaneous coronary intervention.
After propensity score overlap weighting was applied, according to the authors, the hazard ratio was 0.75 (95% CI, 0.74-0.76) for all-cause mortality, 0.80 (95% CI, 0.78-0.81) for cardiovascular mortality, and 0.92 (95% CI, 0.91-0.94) for a composite of ASCVD events when comparing statin users with nonusers.
“Among U.S. veterans 75 years and older and free of ASCVD at baseline, new statin use was significantly associated with a lower risk of all-cause and cardiovascular mortality,” the researchers emphasized. “Further research, including from randomized clinical trials, is needed to more definitively determine the role of statin therapy in older adults for primary prevention of ASCVD.”
“There are many interesting leads to follow up on, “Dr. Orkaby added, “but it’s important to keep in mind that this is not a randomized, clinical trial. Instead, it’s a retrospective analysis using real world data that helps us explore where the truth lies.”
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Researchers from Brigham and Women’s Hospital and the Veterans Affairs Boston Healthcare System looked at the benefits of statins in veterans aged 75 years and older, and their results raise questions about the benefits of discontinuation.
The report in the Journal of the American Medical Association pointed out that the research was necessary because, even though studies have persistently found that statins can prevent heart attacks, strokes, and death in middle-aged adults, only 2% of participants in 28 major clinical trials of statins were age 75 years or older.
Results indicate that patients who had not yet experienced a heart attack, stroke, or other cardiovascular event had a 25% lower risk of dying from any cause if they were treated with statins compared with those who were not. In addition, the risk of dying from a cardiovascular event, such as a heart attack or stroke, was lower by 20%.
“Based on these data, age is not a reason to not prescribe statins,” said lead and corresponding author Ariela Orkaby, MD, MPH, a physician-scientist at VA Boston Health Care System and in the Division of Aging at the Brigham and Women's Hospital. “Statins are commonly studied and prescribed for middle-aged adults but understudied in people over age 75. One of the most remarkable things about our results is that we found the benefit of statins held true regardless of whether a person was older or younger or had a condition such as dementia.”
Defined as primary outcomes in the retrospective analysis were all-cause and cardiovascular mortality. Secondary outcomes included a composite of atherosclerotic cardiovascular disease (ASCVD) events, including myocardial infarction, ischemic stroke, and revascularization with coronary artery bypass graft surgery or percutaneous coronary intervention.
After propensity score overlap weighting was applied, according to the authors, the hazard ratio was 0.75 (95% CI, 0.74-0.76) for all-cause mortality, 0.80 (95% CI, 0.78-0.81) for cardiovascular mortality, and 0.92 (95% CI, 0.91-0.94) for a composite of ASCVD events when comparing statin users with nonusers.
“Among U.S. veterans 75 years and older and free of ASCVD at baseline, new statin use was significantly associated with a lower risk of all-cause and cardiovascular mortality,” the researchers emphasized. “Further research, including from randomized clinical trials, is needed to more definitively determine the role of statin therapy in older adults for primary prevention of ASCVD.”
“There are many interesting leads to follow up on, “Dr. Orkaby added, “but it’s important to keep in mind that this is not a randomized, clinical trial. Instead, it’s a retrospective analysis using real world data that helps us explore where the truth lies.”
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