Statins Reduce CVD Risk in Adults 75 and Older, Study Finds

Novel real-world evidence demonstrated the benefit of statin therapy for the primary prevention of cardiovascular diseases (CVDs) in elderly patients, addressing uncertainties in current global clinical guidelines.¹

These data indicated continuous statin therapy was linked to a significant relative risk reduction in CVDs of 21% among individuals aged 75–84 years and 35% for those aged ≥85 years, without increasing the likelihood of severe adverse events.

“These findings have significant implications for informing clinical decisions regarding the initiation of statin therapy for this increasingly large population group,” said Cindy Lam Lo-kuen, MBBS, MD, Danny DB Ho Professor in Family Medicine, HKUMed.² “This study also pioneered a new research method to explore many more important but unanswered clinical questions related to the care of the elderly in real-world practice.”

CVDs are the leading cause of death worldwide, with an estimated 17.9 million people dying from CVDs in 2019, or 32% of all global deaths.³ Global patterns of total CVD significantly implicate clinical practice and public health policy development. As a result of significant population growth and aging, prevalent cases of CVD are expected to increase in the coming decades substantially.

Statins are commonly used to benefit lipid profiles and reduce the risk of CVDs and all-cause mortality. Still, there is limited consensus on statin use for primary prevention in patients aged ≥75 years in current international guidelines, often attributed to the underrepresentation of elderly individuals in randomized controlled trials (RCTs).⁴

The present study used real-world data to evaluate the long-term benefit-risk profile of statin therapy in primary prevention among older adults.¹ Investigators searched public electronic medical records between January 2008 and December 2018 of ≥80,000 older individuals in Hong Kong with suboptimal lipid levels and CVD risk factors, including diabetes.

Target trial emulation incorporated key features of RCTs in the study design and evaluated statin therapy’s relationship with CVD risk. This approach reduced the bias typically associated with observational studies.

A total of 69,981 individuals aged 75 to 84 years and 14,555 aged ≥85 years were considered eligible for analysis. Among 42,680 matched person-trials aged 75 to 84 years, and 5390 matched person-trials aged ≥85 years, 9676 and 1600 patients, respectively, developed CVDs in each age cohort.

Upon analysis, in the 75–84 age cohort, the continual use of statin therapy was linked to a 21% relative risk reduction and an absolute risk reduction of 5% over 5 years. Among the cohort aged ≥85, the relative risk reduction was 35% and the absolute risk reduction was 12.5% after 5 years of statin therapy.

Safety data revealed no significantly increased risk of major adverse events, including liver dysfunction or myopathies, with statin use across both age groups.

Overall, these data confirmed the benefit-risk profile of statins for primary prevention of CVD in the vulnerable older population. As a result, investigators suggested that advanced age should not serve as a deterrent for high-risk patients when considering the benefit of statin therapy.

“The older population, especially very old adults, are generally underrepresented in the RCTs, leading to a lack of high-quality evidence on treatment for this specific population group,” said Eric Wan Yuk-fai, assistant professor and chief of research in the department of family medicine and primary care, HKUMed.² “The innovative approach adopted in this study has the potential to generate high-quality evidence in the field of geriatric medicine, thereby advancing our understanding and improving healthcare outcomes for older populations.”

References

1. _{Xu W, Lee AL, Lam CLK, Danaei G, Wan EYF. Benefits and Risks Associated With Statin Therapy for Primary Prevention in Old and Very Old Adults: Real-World Evidence From a Target Trial Emulation Study. Ann Intern Med. 2024;177(6):701-710. doi:10.7326/M24-0004}
2. _{HKUMed and Harvard world-first study finds statins reduce the relative risk of cardiovascular diseases by over 20% in adults aged 75+ with high cholesterol in Hong Kong. EurekAlert! June 26, 2024. Accessed July 9, 2024. https://www.eurekalert.org/news-releases/1049534.}
3. _{Roth GA, Mensah GA, Johnson CO, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study [published correction appears in J Am Coll Cardiol. 2021 Apr 20;77(15):1958-1959. doi: 10.1016/j.jacc.2021.02.039]. J Am Coll Cardiol. 2020;76(25):2982-3021. doi:10.1016/j.jacc.2020.11.010}
4. _{Statin therapy in older adults for primary prevention of atherosclerotic cardiovascular disease: The balancing act. American College of Cardiology. October 1, 2020. Accessed July 9, 2024. https://www.acc.org/Latest-in-Cardiology/Articles/2020/10/01/11/39/Statin-Therapy-in-Older-Adults-for-Primary-Prevention-of-Atherosclerotic-CV-Disease.}