Safety and Effectiveness of Statins for Prevention of Recurrent Myocardial Infarction in 12 156 Typical Older Patients: A Quasi-Experimental Study

Abstract

Background: There is limited evidence on statin risk and effectiveness for patients aged 80+. We estimated risk of recurrent myocardial infarction, muscle-related and other adverse events, and statin-related incremental costs in “real-world” older patients treated with statins versus no statins.Methods: We used primary care electronic medical records from the UK Clinical Practice Research Datalink. Subhazard ratios (competing risk of death) for myocardial infarction recurrence (primary end point), falls, fractures, ischemic stroke, and dementia, and hazard ratios (Cox) for all-cause mortality were used to compare older (60+) statin users and 1:1 propensity-score-matched controls (n = 12,156). Participants were followed-up for 10 years.Results: Mean age was 76.5±9.2 years; 45.5% were women. Statins were associated with near significant reduction in myocardial infarction recurrence (subhazard ratio = 0.84, 0.69–1.02, p = .073), with protective effect in the 60–79 age group (0.73, 0.57–0.94) but a nonsignificant result in the 80+ group (1.06, 0.78–1.44; age interaction p = .094). No significant associations were found for stroke or dementia. Data suggest an increased risk of falls (1.36, 1.17–1.60) and fractures (1.33, 1.04–1.69) in the first 2 years of treatment, particularly in the 80+ group. Treatment was associated with lower all-cause mortality. Statin use was associated with health care cost savings in the 60–79 group but higher costs in the 80+ group.Conclusions: Estimates of statin effectiveness for the prevention of recurrent myocardial infarction in patients aged 60–79 years were similar to trial results, but more evidence is needed in the older group. There may be an excess of falls and fractures in very old patients, which deserves further investigation.

Statins After Myocardial Infarction in the Oldest: A Cohort Study in the Clinical Practice Research Datalink Database

“…These studies tended to report a greater effect of statin therapy than we found, which probably is an overestimation. One study using the data from the CPRD database reported no beneficial effect of statins on MI recurrence in patients aged 80 years and older . This might be explained by the large proportion of patients in the user group (43%) who discontinued therapy within 2 years of statin initiation and by the exclusion of patients who started statin therapy more than 2 months after the event.…”

“…Most observational studies of older populations (mean age = 74‐87 years) suggest that statins have a protective effect against MI recurrence and mortality . The most recent studies found no effect of statin therapy after an MI . Moreover, in these studies, statin use was defined at a fixed moment, mostly at hospital discharge, which does not account for cumulative statin exposure thereafter.…”

Underutilization of Statin Therapy for Secondary Prevention of Cardiovascular Disease Among Older Adults

“…The benefits of adding high-intensity statin therapy are most consistent for all-cause mortality with significant reductions in mortality rates within the short term (ie, 3 months) as well as longer term (ie, at least 10 years). 2,5,6,12,14–17,21,24 The benefit of reduced nonfatal CVD-related hospitalizations is confounded by higher CVD risk levels associated with those on higher statin dosages. 12,14,15,25 Offsetting the benefits of statins, there is a concern for undesirable side effects including musculoskeletal pain (eg, myalgia), muscle weakness, reduced mobility, and increased falls, especially associated with higher dosages or long-term statin use.…”

“…12,14,15,25 Offsetting the benefits of statins, there is a concern for undesirable side effects including musculoskeletal pain (eg, myalgia), muscle weakness, reduced mobility, and increased falls, especially associated with higher dosages or long-term statin use. 2,13,14,20,21,24,26–28 Although side effects have been documented in 5%–10% of patients, the negative risks associated with statin therapy generally are associated with early stages of therapy. 2,13,24,29…”

“…2,13,14,20,21,24,26–28 Although side effects have been documented in 5%–10% of patients, the negative risks associated with statin therapy generally are associated with early stages of therapy. 2,13,24,29…”