Statin Use in Older Adults with Stable Atherosclerotic Cardiovascular Disease

Abstract

Background/Objectives Older adults (>75 years of age) represent two‐thirds of atherosclerotic cardiovascular disease (ASCVD) deaths. The 2013 and 2018 American multi‐society cholesterol guidelines recommend using at least moderate intensity statins for older adults with ASCVD. We examined annual trends and statin prescribing patterns in a multiethnic population of older adults with ASCVD. Design Retrospective longitudinal study using electronic health record (EHR) data from 2007 to 2018. Setting A large multi‐specialty health system in Northern California. Participants A total of 24,651 adults older than 75 years with ASCVD. Measurements Statin prescriptions for older adults with known ASCVD were trended over time. Multivariable regression models were used to identify predictors of statin prescription (logistic) after controlling for relevant demographic and clinical factors. Results The study cohort included 24,651 patients older than 75 years; 48% were women. Although prescriptions for moderate/high intensity statins increased over time for adults over 75, fewer than half of the patients (45%) received moderate/high intensity statins in 2018. Women (odds ratio (OR) = 0.77; 95% confidence interval (CI) = 0.74, 0.80), patients who had heart failure (OR = 0.69; 95% CI = 0.65, 0.74), those with dementia (OR = 0.88; 95% CI = 0.82, 0.95) and patients who were underweight (OR = 0.64; 95% CI = 0.57, 0.73) were less likely to receive moderate/high intensity statins. Conclusions Despite increasing prescription rates between 2007 and 2018, guideline‐recommended statins remained underused in older adults with ASCVD, with more pronounced disparities among women and those with certain comorbidities. Future studies are warranted to examine reasons for statin underuse in older adults with ASCVD.

Statin Use in Older Adults for Primary Cardiovascular Disease Prevention Across a Spectrum of Cardiovascular Risk

“…Prior studies of secondary prevention have demonstrated the treatment-risk paradox of statin therapy in older adults. 21,25,26 Although statins were not clearly protective in Table 3, this finding is inconsistent with protective effects demonstrated in prior work and must be interpreted with caution based on the observational nature of the present study. Older adults may have multimorbidity, frailty, and life expectancy considerations that may affect statin use decisions.…”

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

“…Among 24 651 adults > 75 years of age (48% females) receiving ASCVD care at a health system in Northern California between 2007 and 2018, prescriptions for moderate- or high-intensity statin therapy increased over time. 54 However, fewer than half of patients (45%) received moderate- or high-intensity statins in 2018. Lower use of statin therapy was observed in females (OR, 0.77 [95% CI, 0.74–0.80]), patients with HF (OR, 0.69 [95% CI, 0.65–0.74]), patients with dementia (OR, 0.88 [95% CI, 0.82–0.95]), and underweight patients (OR, 0.64 [95% CI, 0.57–0.73]).…”

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…Among 24 651 adults > 75 years of age (48% females) receiving ASCVD care at a health system in Northern California between 2007 and 2018, prescriptions for moderate- or high-intensity statin therapy increased over time. 53 However, fewer than half of patients (45%) received moderate- or high-intensity statins in 2018. Lower use of statin therapy was observed in females (OR, 0.77 [95% CI, 0.74–0.80]), patients with HF (OR, 0.69 [95% CI, 0.65–0.74]), patients with dementia (OR, 0.88 [95% CI, 0.82–0.95]), and patients with underweight (OR, 0.64 [95% CI, 0.57–0.73]).…”