Hong Kong—How old is too old to continue to receive statins for prevention of cardiovascular disease (CVD)?

That is the question addressed in a new article in Annals of Internal Medicine. The short answer is that prescribers should not be in a hurry to discontinue the statins.

“There is little consensus on using statins for primary prevention of cardiovascular diseases (CVDs) and all-cause mortality in adults aged 75 years or older due to the underrepresentation of this population in randomized controlled trials,” University of Hong Kong researchers wrote.

Their study sought to investigate the benefits and risks of using statins for primary prevention in old (aged 75-84 years) and very old (aged 85 years and older) adults. To do that, the study team used sequential target trial emulation comparing matched cohorts initiating versus not initiating statin therapy.

Data came from territory-wide public electronic medical records in Hong Kong. The study included adults aged 75 years or older who met indications for statin initiation from January 2008 to December 2015.

The study excluded from analysis those participants with preexisting diagnosed CVDs at baseline, such as coronary heart disease (CHD). The authors reported that among the 69,981 eligible persons aged 75 to 84 years and 14,555 persons aged 85 years or older, 41,884 and 9,457, respectively, had history of CHD equivalents (e.g., diabetes) in the respective age groups.

The focus was on the incidence of major CVDs (stroke, myocardial infarction, or heart failure), all-cause mortality, and major adverse events (myopathies and liver dysfunction) after the initiation of statin therapy.

The results showed that of the 42,680 matched person-trials aged 75 to 84 years and 5,390 matched person-trials aged 85 years or older (average follow-up 5.3 years), 9,676 and 1,600 of them developed CVDs in each age group, respectively.

“Risk reduction for overall CVD incidence was found for initiating statin therapy in adults aged 75 to 84 years (5-year standardized risk reduction, 1.20% [95% CI, 0.57% to 1.82%] in the intention-to-treat [ITT] analysis; 5.00% [CI, 1.11% to 8.89%] in the per protocol [PP] analysis) and in those aged 85 years or older (ITT: 4.44% [CI, 1.40% to 7.48%]; PP: 12.50% [CI, 4.33% to 20.66%]),” the researchers reported. “No significantly increased risks for myopathies and liver dysfunction were found in both age groups.”

While the study might have been limited by unmeasured confounders, such as lifestyle factors of diet and physical activity, the authors concluded, “Reduction for CVDs after statin therapy were seen in patients aged 75 years or older without increasing risks for severe adverse effects. Of note, the benefits and safety of statin therapy were consistently found in adults aged 85 years or older.”

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