Cardiovascular disease (CVD) has become the worldwide leading cause of death. The most vulnerable section of the society to experience CVD are the elderly, with incidence and mortality rates nearly three times higher in those older than 74 years as compared to those below 74 years of age. In addition, people older than 74 years will represent more than 10% of the population in developed countries by the year 2050 according to the projections of population growth.1

Statins are the first choice of agents to reduce high blood cholesterol levels, which are a risk factor for CVD.2 Evidence from the meta-analysis and randomized clinical trials support statin treatment for the secondary prevention of CVD in patients aged 75 years and older. Meta-analysis data also support statins for the primary prevention of CVD in patients aged 65 years or more. However, the evidence does not include people aged more than 74 years, especially those aged more than 84 years–the age group who are understated in observational studies and clinical trials.1,2

This concern is also applicable to older patients with type 2 diabetes mellitus–a predominantly high-risk group in the primary prevention of CVD. People with persistent diabetes have a risk of coronary heart disease much the same as people with a history of coronary heart disease. However, the advantages of statins in the primary prevention in older people with diabetes have still not been evaluated adequately.1

What do studies conducted on statin treatment for CVD reveal?

A retrospective cohort study was conducted on 46,864 people aged 75 years or more who were not recognized clinically with atherosclerotic CVD. The patients were arranged by statin non-users, new users and by the presence of type 2 diabetes. The study aimed to evaluate if treatment with statins is linked to a reduction in atherosclerotic CVD and mortality in old and very old adults with or without diabetes. The study was carried out using data from the Spanish Information System for the Development of Research in Primary Care (SIDIAP).1

In participants aged 75 to 84 years without diabetes, hazard ratios for statin use were 0.94 for atherosclerotic CVD and 0.98 for all-cause mortality and, in participants aged 85 and older, the hazard ratios were 0.93 and 0.97, respectively. In participants aged 75 to 84 years with diabetes, the hazard ratio for statin use was 0.76 for atherosclerotic CVD and 0.84 for all-cause mortality and, in participants aged 85 and older, the hazard ratios were 0.82 and 1.05, respectively.1

Effect analysis of age on a continuous scale, using splines, in participants without diabetes older than 74 years verified the lack of beneficial effect of statins in atherosclerotic CVD and all-cause mortality. Statins showed a protecting effect against atherosclerotic CVD and all-cause mortality in participants with diabetes, which significantly reduced beyond the age of 85 and disappeared in nonagenarians.1

Conclusion

Statin treatment was not connected to a reduction in atherosclerotic CVD or all-cause mortality even when the occurrence of atherosclerotic CVD was statistically considerably higher than the risk thresholds anticipated with statin use in participants older than 74 years of age without type 2 diabetes. However, in the presence of diabetes, statin use was significantly statistically connected to a reduction in the occurrence of atherosclerotic CVD and all-cause mortality.1

References

  1. Ramos R, Comas-Cufí M, Martí-Lluch R, et.al. Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective study. 2018 Sep 5;362:k3359. doi: 10.1136/bmj.k3359.     https://www.bmj.com/content/362/bmj.k3359
  2.  Taylor F, Huffman M.D., Macedo A.F, et.al. Statins for the primary prevention of cardiovascular disease. Cochrane database of systematic reviews. 2013 Jan 31;(1):CD004816. doi: 10.1002/14651858.CD004816.pub5 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004816.pub5/full