Are you over 65 & taking statin meds? Know anyone who is? It may not be worth it.
Posted by Warm Southern Breeze on Sunday, June 18, 2017
If you’re a prescriber, consider this research. If you’re a patient, or know someone who is, consider this for your, or their well-being.
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Statins Have No Primary CVD Prevention Benefit To Older Patients
Takeaway
Statins offer no benefit for the primary prevention of cardiovascular disease (CVD) in adult patients aged ≥65 y.
Why this matters
“[S]tatins may be producing untoward effects in the function or health of older adults that could offset any possible cardiovascular benefit,” say the study authors.
Study design
Researchers conducted post hoc secondary data analyses of patient data from a randomized, open-label clinical trial (N=2867; age, ≥65 y; 49.4% women; all without evidence of atherosclerotic cardiovascular disease); patients were assigned to either a treatment group receiving pravastatin sodium 40 mg/d or a usual care (UC) group.
Funding: National Heart, Lung, and Blood Institute; AstraZeneca; Bristol-Myers Squibb; Pfizer; National Center for Advancing Translational Sciences; The Stroke Foundation.
Key results
Hazard ratios for all-cause mortality in the treatment group vs the UC group were 1.18 (P=.09) for patients aged 65 y and older, 1.08 (P=.55) for patients aged 65-74 y, and 1.34 (P =.07) for patients aged 75 y and older.
Coronary heart disease event rates were not significantly different among groups.
Limitations
The study did not include patients who were receiving statin therapy at baseline.
Question Are statins beneficial when used for primary cardiovascular prevention in older adults?
Findings In this post hoc secondary analysis of older adults in the randomized clinical trial Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial–Lipid-Lowering Trial (ALLHAT-LLT), there were no significant differences in all-cause mortality or cardiovascular outcomes between pravastatin sodium and usual care for primary prevention for adults 65 years and older.
Meaning No benefit was found when a statin was given for primary prevention to older adults. Treatment recommendations should be individualized for this population.
Importance While statin therapy for primary cardiovascular prevention has been associated with reductions in cardiovascular morbidity, the effect on all-cause mortality has been variable. There is little evidence to guide the use of statins for primary prevention in adults 75 years and older.
Objectives To examine statin treatment among adults aged 65 to 74 years and 75 years and older when used for primary prevention in the Lipid-Lowering Trial (LLT) component of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT).
Design, Setting, and Participants Post hoc secondary data analyses were conducted of participants 65 years and older without evidence of atherosclerotic cardiovascular disease; 2867 ambulatory adults with hypertension and without baseline atherosclerotic cardiovascular disease were included. The ALLHAT-LLT was conducted from February 1994 to March 2002 at 513 clinical sites.
Interventions Pravastatin sodium (40 mg/d) vs usual care (UC).
Main Outcomes and Measures 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 (coronary heart disease events).
Results There were 1467 participants (mean [SD] age, 71.3 [5.2] years) in the pravastatin group (48.0% [n = 704] female) and 1400 participants (mean [SD] age, 71.2 [5.2] years) in the UC group (50.8% [n = 711] female). The baseline mean (SD) low-density lipoprotein cholesterol levels were 147.7 (19.8) mg/dL in the pravastatin group and 147.6 (19.4) mg/dL in the UC group; by year 6, the mean (SD) low-density lipoprotein cholesterol levels were 109.1 (35.4) mg/dL in the pravastatin group and 128.8 (27.5) mg/dL in the UC group. At year 6, of the participants assigned to pravastatin, 42 of 253 (16.6%) were not taking any statin; 71.0% in the UC group were not taking any statin. The hazard ratios for all-cause mortality in the pravastatin group vs the UC group were 1.18 (95% CI, 0.97-1.42; P = .09) for all adults 65 years and older, 1.08 (95% CI, 0.85-1.37; P = .55) for adults aged 65 to 74 years, and 1.34 (95% CI, 0.98-1.84; P = .07) for adults 75 years and older. Coronary heart disease event rates were not significantly different among the groups. In multivariable regression, the results remained nonsignificant, and there was no significant interaction between treatment group and age.
Conclusions and Relevance 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.
Trial Registration clinicaltrials.gov Identifier: NCT00000542
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2628971
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