Association of Statin Use With All-Cause and Cardiovascular Mortality in US Veterans 75 Years and Older

Abstract

IMPORTANCE Data are limited regarding statin therapy for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in adults 75 years and older.OBJECTIVE To evaluate the role of statin use for mortality and primary prevention of ASCVD in veterans 75 years and older. DESIGN, SETTING, AND PARTICIPANTSRetrospective cohort study that used Veterans Health Administration (VHA) data on adults 75 years and older, free of ASCVD, and with a clinical visit in 2002-2012. Follow-up continued through December 31, 2016. All data were linked to Medicare and Medicaid claims and pharmaceutical data. A new-user design was used, excluding those with any prior statin use. Cox proportional hazards models were fit to evaluate the association of statin use with outcomes. Analyses were conducted using propensity score overlap weighting to balance baseline characteristics.EXPOSURES Any new statin prescription. MAIN OUTCOMES AND MEASURESThe primary outcomes were all-cause and cardiovascular mortality. Secondary outcomes included a composite of ASCVD events (myocardial infarction, ischemic stroke, and revascularization with coronary artery bypass graft surgery or percutaneous coronary intervention). RESULTSOf 326 981 eligible veterans (mean [SD] age, 81.1 [4.1] years; 97% men; 91% white), 57 178 (17.5%) newly initiated statins during the study period. During a mean follow-up of 6.8 (SD, 3.9) years, a total 206 902 deaths occurred including 53 296 cardiovascular deaths, with 78.7 and 98.2 total deaths/1000 person-years among statin users and nonusers, respectively (weighted incidence rate difference [IRD]/1000 person-years, -19.5 [95% CI, -20.4 to -18.5]). There were 22.6 and 25.7 cardiovascular deaths per 1000 person-years among statin users and nonusers, respectively (weighted IRD/1000 person-years, -3.1 [95 CI, -3.6 to -2.6]). For the composite ASCVD outcome there were 123 379 events, with 66.3 and 70.4 events/1000 person-years among statin users and nonusers, respectively (weighted IRD/1000 person-years, -4.1 [95% CI, -5.1 to -3.0]). After propensity score overlap weighting was applied, the hazard ratio was 0.75 (95% CI, 0.74-0.76) for all-cause mortality, 0.80 (95% CI, 0.78-0.81) for cardiovascular mortality, and 0.92 (95% CI, 0.91-0.94) for a composite of ASCVD events when comparing statin users with nonusers.CONCLUSIONS AND RELEVANCE Among US veterans 75 years and older and free of ASCVD at baseline, new statin use was significantly associated with a lower risk of all-cause and cardiovascular mortality. Further research, including from randomized clinical trials, is needed to more definitively determine the role of statin therapy in older adults for primary prevention of ASCVD.

Consistent Use of Lipid Lowering Therapy in HIV Infection Is Associated with Low Mortality

“…Prior HIV cohort analyses have reported a disproportionately large statin-associated mortality bene t of > 50% [9][10][11] which resembles reports of ≥ 40% reduced mortality among statin users in other populations with altered immunity [27][28][29], inherently increased (cardiovascular) mortality risk [30][31][32][33], or old age (25% mortality reduction in men > 75 years) [34]. Decreased mortality had never been observed in primary NS-LLT prevention trials but has recently been reported when icosapent-ethyl ( sh oil component) or alirocumab (PSK-9 inhibitor) was added to statins in high-risk populations [35,36].…”

Statin Effects in Atrial Fibrillation-Related Stroke: A Systematic Review and Meta-Analysis

“…However, in this meta-analysis, statin therapy did not reduce the vascular events, including recurrent ischemic stroke, acute coronary events, and MACE. Recent cohort studies involving older adult participants without atherosclerotic cardiovascular disease have reported that statin treatment has a major advantage for mortality over prevention of ischemic stroke or myocardial infarction ( 27 ).…”

Statin therapy for primary cardiovascular prevention in adults older than 75 years

“…Among US Veterans above the age of 75, one study found that initiation of statin therapy for primary prevention significantly reduced all-cause and cardiovascular mortality [36]. This study retrospectively analyzed 326,981 veterans (average age 81.1, of which 97% were men and 91% were white).…”