Jul 7, 2020

Disclosures: Orkaby and Nelson report no relevant financial disclosures. Nicholls reports he received a principal research fellowship from the National Health and Medical Research Council of Australia; received research support from Amgen, Anthera, AstraZeneca, Cerenis, Eli Lilly, InfraReDx, LipoScience, The Medicines Company, Novartis, Resverlogix, Roche and Sanofi-Regeneron, and received consultant fees and honoraria from Anthera, AstraZeneca, Boehringer Ingelheim, CSL Behring, Eli Lilly, Esperion, Merck, Omthera, Resverlogix, Sanofi-Regeneron and Takeda. Please see the study for all other authors’ relevant financial disclosures. ADD TOPIC TO EMAIL ALERTS Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . Please try again later. If you continue to have this issue please contact customerservice@slackinc.com . Back to Healio Statin initiation in older U.S. veterans free from atherosclerotic CVD at baseline reduced the risk for CV and all-cause mortality, researchers found in a retrospective cohort study. “In this retrospective analysis, we found that the risk of dying from any cause was lower by 25% among veterans who were newly prescribed a statin compared with those who were not treated with statins,” Ariela R. Orkaby, MD, MPH, geriatrician and researcher at the VA Boston Health Care System and in the division of aging at Brigham and Women’s Hospital and Harvard Medical School, told Healio. “The risk of dying from a cardiovascular event such as a heart attack or stroke was lower by 20%. Secondarily, the risk of an overall cardiovascular event, including heart attacks, strokes , coronary bypass surgery or coronary catheterization, was 8% lower in those prescribed a statin compared with those who were not prescribed a statin.” Source: Adobe Stock. Older patients without ASCVD In this study published in JAMA, researchers analyzed data from 326,981 patients (mean age, 81 years; 97% men) aged 75 years and older who regularly used U.S. Veterans Affairs services between 2002 and 2012. All patients were free from ASCVD at baseline, defined as a history of transient ischemic attack or stroke, MI, coronary revascularization or peripheral vascular disease. No patients were taking statins at entry into the cohort but were monitored for initiation throughout the study. The primary outcomes for this study were CV and all-cause mortality . Secondary outcomes included ischemic stroke, MI, revascularization and a composite of these ASCVD events. From baseline, new statin users accounted for 17.5% of the patient population in this study. There were 206,902 deaths including 53,296 CV deaths during a mean follow-up of 6.8 years. This equaled to 78.7 total deaths per 1,000 person-years in patients taking statins compared with 98.2 total deaths per 1,000 person-years in those not taking statins before adjustment (weighted incidence rate difference per 1,000 person-years, 19.5; 95% CI, 20.4 to 18.5). For CV deaths, there were 22.6 deaths per 1,000 person-years in the statin group vs. 25.7 deaths per 1,000 person-years in the nonstatin group (weighted incidence rate difference per 1,000 person-years, 3.1; 95% CI, 3.6 to 2.6). During follow-up, there were 123,379 composite ASCVD events. This equated to 66.3 events per 1,000 person-years in patients taking statins compared with 70.4 events per 1,000 person-years in those not taking the medications (weighted incidence rate difference per 1,000 person-years, 4.1; 95% CI, 5.1 to 3). PAGE BREAK Researchers applied propensity score overlap weighting to this data, which showed that statin use was significantly linked to a lower risk for CV death (HR = 0.8; 95% CI, 0.78-0.81) and all-cause mortality (HR = 0.75; 95% CI, 0.74-0.76) when compared with those not taking statins. The HR for a composite of ASCVD events was 0.92 when comparing these two groups (95% CI, 0.91-0.94). Ariela R. Orkaby “Age alone should not be a reason not to prescribe a statin to older adults,” Orkaby said in an interview. Orkaby added that more research is needed in this area. She said, “Although real-world, carefully conducted epidemiologic studies like this one are very useful to further our understanding of the role of statins for cardiovascular prevention, we still need clinical trials, the gold standard of evidence. An exciting new trial called PREVENTABLE will soon begin enrolling participants [aged at least 75 years] across the U.S. to help us further understand the role of statins in this age group.” ‘Fastest-growing population subgroups’ Stephen J. Nicholls In a related editorial, Stephen J. Nicholls, MBBS, PhD, director of Monash Heart and professor at Monash University in Melbourne, Australia, and Adam J. Nelson, MBBS, PhD, postdoctoral cardiology fellow at Duke Clinical Research Institute, North Carolina, wrote: “The findings of the study by Orkaby et al provide additional support for treatment guidelines that have increasingly advocated for more widespread use of statin therapy for ASCVD prevention in older individuals. While randomized trials will provide the most definitive data to support these recommendations, observational data from large cohorts have the potential to guide clinical practice in the interim. Because patients older than 75 years represent one of the fastest-growing population subgroups in health care systems, there is a major need to provide an evidence base that informs use of therapies that are both safe and efficacious, in a cost-effective manner.” Reference: