Statin Treatment and Mortality in Community-Dwelling Frail Older Patients with Diabetes Mellitus: A Retrospective Observational Study

Abstract

BackgroundOlder adults are often excluded from clinical trials. Decision making for administration of statins to older patients with diabetes mellitus (DM) is under debate, particularly in frail older patients with comorbidity and high mortality risk. We tested the hypothesis that statin treatment in older patients with DM was differentially effective across strata of mortality risk assessed by the Multidimensional Prognostic Index (MPI), based on information collected with the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA).MethodsIn this retrospective observational study, we estimated the mortality risk in 1712 community-dwelling subjects with DM ≥ 65 years who underwent a SVaMA evaluation to establish accessibility to homecare services/nursing home admission from 2005 to 2013 in the Padova Health District, Italy. Mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) risk of mortality at baseline and propensity score-adjusted hazard ratios (HR) of three-year mortality were calculated according to statin treatment.ResultsHigher MPI-SVaMA scores were associated with lower rates of statin treatment (MPI-SVaMA-1 = 39% vs MPI-SVaMA-2 = 36% vs MPI-SVaMA-3 = 24.9%. p<0.001) and higher three-year mortality (MPI-SVaMA-1 = 12.9% vs MPI-SVaMA-2 = 24% vs MPI-SVaMA-3 = 34.4%, p<0.001). After adjustment for propensity score quintiles, statin treatment was significantly associated with lower three-year mortality irrespective of MPI-SVaMA group (interaction test p = 0.303). HRs [95% confidence interval (CI)] were 0.19 (0.14–0.27), 0.28 (0.21–0.36), and 0.26 (0.20–0.34) in the MPI-SVaMA-1, MPI-SVaMA-2, and MPI-SVaMA-3 groups, respectively. Subgroup analyses showed that statin treatment was also beneficial irrespective of age. HRs (95% CI) were 0.21 (0.15–0.31), 0.26 (0.20–0.33), and 0.26 (0.20–0.35) among patients aged 65–74, 75–84, and ≥ 85 years, respectively (interaction test p=0.812).ConclusionsStatin treatment was significantly associated with reduced three-year mortality independently of age and multidimensional impairment in community-dwelling frail older patients with DM.

Association of Antidementia Drugs and Mortality in Community-Dwelling Frail Older Patients With Dementia: The Role of Mortality Risk Assessment

“…Very recently, the MPI-SVaMA has been implemented in older people to evaluate whether a different individual prognostic profile was associated with different mortality rates after treatment for specific disorders (ie, statins in older patients with diabetes mellitus 41 or coronary artery disease 42 as well as anticoagulants in older patients with atrial fibrillation). 43 These studies suggested that full access to prognostic information derived from CGA-based predictive tools better equips physicians to make clinical decisions aligned with their patients’ needs in terms of safety and efficacy.…”

Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease

“…In a large sample of community-dwelling frail older patients with diabetes mellitus, statin treatment was associated with a reduced 3-year mortality rate, suggesting that a severely compromised health and functional status, or a very old age, did not affect the association between statin treatment and reduced mortality. 10 The objective of the present study was to test the hypothesis that effectiveness of statin treatment in community-dwelling frail older patients with CAD may vary across strata of mortality risk in a 3-year follow-up period.…”

Deprescribing Statins—Is It Ethical?

“…In a population‐based study, they did not find significantly less dementia in statin users (although point estimate was clearly below unity) but nevertheless noted significantly lower mortality in statin users than nonusers. The totality of the evidence in older adults, and even in frail individuals and those with multimorbidity, supports this finding . Gnjidic and colleagues may also have misinterpreted the review of Desai and colleagues by stating that there is growing evidence of adverse effects of statins.…”