New York—Questions are being raised about the usefulness of statins to prevent adverse cardiovascular and mortality outcomes in older adults with hypertension and moderately high cholesterol.
Researchers from the New York University School of Medicine and colleagues took another look at data from older adults who participated in the Lipid-Lowering Trial (LLT) component of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT), which was conducted from 1994 to 2002.
Their results, published in JAMA Internal Medicine, suggest no benefit from a statin in those patients for all-cause mortality or coronary heart disease events. The primary outcome in the ALLHAT-LLT was all-cause mortality; secondary outcomes included cause-specific mortality and nonfatal myocardial infarction or fatal coronary heart disease combined.
Included in the analytical sample were 2,867 adults with hypertension but without baseline atherosclerotic cardiovascular disease; 1,467 were in the pravastatin sodium group taking 40 mg per day and the other 1,400 received usual care from their primary care physician to lower cholesterol.
Results indicate that more deaths occurred in the pravastatin group than in the usual- care group—141 versus 130—among adults 65 to 74, as well as among adults 75 and older—92 versus 65. Furthermore, not much difference was detected in coronary heart disease rates between the intervention and control groups. Stroke, heart failure, and cancer rates also varied little, according to the report.
The article noted adverse effects of statins on physical or mental functioning of older adults, as well as the higher risk in patients older than 65 for hospitalization for rhabdomyolysis, development of muscle issues, and fatigue. Study authors suggest that reconsidering use of the drugs in some patients could be positive, adding that “It is possible that, for vulnerable older adults, statins may have negative effects on function.”
“No benefit was found when pravastatin was given for primary prevention to older adults with moderate hyperlipidemia and hypertension, and a nonsignificant direction toward increased all-cause mortality with pravastatin was observed among adults 75 years and older,” the researchers conclude.
The study has some limitations, according to the authors, because it was designed as a post hoc secondary analysis of a trial of a subgroup of patients.
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