Statin Use and Adverse Effects Among Adults >75 Years of Age: Insights From the Patient and Provider Assessment of Lipid Management (PALM) Registry

Abstract

BackgroundCurrent statin use and symptoms among older adults in routine community practice have not been well characterized since the release of the 2013 American College of Cardiology/American Heart Association guideline.Methods and ResultsWe compared statin use and dosing between adults >75 and ≤75 years old who were eligible for primary or secondary prevention statin use without considering guideline‐recommended age criteria. The patients were treated at 138 US practices in the Patient and Provider Assessment of Lipid Management (PALM) registry in 2015. Patient surveys also evaluated reported symptoms while taking statins. Multivariable logistic regression models examined the association between older age and statin use and dosing. Among 6717 people enrolled, 1704 (25%) were >75 years old. For primary prevention, use of any statin or high‐dose statin did not vary by age group: any statin, 62.6% in those >75 years old versus 63.1% in those ≤75 years old (P=0.83); high‐dose statin, 10.2% versus 12.3% in the same groups (P=0.14). For secondary prevention, older patients were slightly less likely to receive any statin (80.1% versus 84.2% [P=0.003]; adjusted odds ratio, 0.81; 95% confidence interval, 0.66–1.01 [P=0.06]), but were much less likely to receive a high‐intensity statin (23.5% versus 36.2% [P<0.0001]; adjusted odds ratio, 0.54; 95% confidence interval, 0.45–0.65 [P=0.0001]). Among current statin users, older patients were slightly less likely to report any symptoms (41.3% versus 46.6%; P=0.003) or myalgias (27.3% versus 33.3%; P<0.001).ConclusionsOverall use of statins was similar for primary prevention in those aged >75 years versus younger patients, yet older patients were less likely to receive high‐intensity statins for secondary prevention. Statins appear to be similarly tolerated in older and younger adults.

Effects of Statin Use for Primary Prevention among Adults Aged 75 Years and Older in the National Health Insurance Service Senior Cohort (2002–2015)

“…Our results are similar to the those of the 2015 the Patient and provider Assessment of Lipid Man agement (PALM) registry, in which statins appeared to be similarly tolerated in older ( > 75 years) and younger adults. 35) Our study has several limitations. First, there was the possibility of coding errors, missing data, lack of clinically relevant data because of unmeasured variables, or missing relevant drug use that was not typically collected in nationally-based datasets.…”

“…Our results are similar to the those of the 2015 the Patient and provider Assessment of Lipid Man­agement (PALM) registry, in which statins appeared to be similarly tolerated in older (>75 years) and younger adults. 35 )…”

The Accuracy of Cardiovascular Pooled Cohort Risk Estimates in U.S. Older Adults

“…Octogenarians are living longer and may benefit from risk-reducing therapies, but evidence supporting these therapies are limited, 1,18 which can lead to treatment differences in older adults at high-risk for future cardiovascular events. 19 Given increasing life expectancies, many patients ages 75 and older can expect to live well over a decade. A clearer understanding of future cardiovascular risk in this population can inform patient-centered conversations regarding pharmacologic therapies with limited randomized-controlled evidence.…”

Role of Statin Therapy in Primary Prevention of Cardiovascular Disease in Elderly Patients

“…Finally, although RCTs of statins have been negative in advanced heart failure, late-stage renal disease, or dementia, neither have specific harms been detected in these most vulnerable patient groups. In a large real-life database, statins appeared to be similarly tolerated in older (> 75 years) and younger adults in primary prevention [ 35 ]. In accordance, health-related quality of life was similar among home-living octogenarian statin users as compared to nonusers [ 36 ].…”