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

Abstract

Secondary cardiovascular disease (CVD) clinical trials have demonstrated that higher intensity levels of statin therapy are more effective than lower levels in reducing mortality rates. Despite updated treatment guidelines, statin therapy may be underutilized, with evidence that females are treated less aggressively than males. The primary objective of this study was to determine the prevalence of statin utilization by varying therapy intensity by sex. The secondary objective was to document the benefits of statin therapy intensity levels on all-cause mortality for males and females. A 25% random sample of adults ≥65 years was utilized to identify those with established CVD. Inclusion criteria included: (1) 12-month pre period and (2) up to 30 months post period. Five categories of statin utilization were established: adherent to high-, moderate-, or low-intensity statin therapy, nonadherent, and no statins. Among eligible insureds (N = 49,530 males; N = 44,710 females), 20% of males and 12% of females were identified as high-intensity statin users. Mortality rates significantly increased similarly for males and females as statin therapy intensity decreased. Likewise, mortality hazard ratios indicated the most benefit from high-intensity statin therapy compared to all other categories. Statin therapy for secondary prevention of CVD is beneficial in reducing mortality for males and females but is underutilized, especially among females. Education programs among patients to increase heart health awareness and among physicians to promote the benefits of updated statin guidelines should be encouraged.

Statin Use in Older Adults with Stable Atherosclerotic Cardiovascular Disease

“…Prescribing statins for older adults requires special considerations which include polypharmacy, multimorbidity, and higher likelihood of frailty and advanced incurable disease 25‐27 . Polypharmacy was associated with increased moderate/high statin prescriptions.…”

A large remaining potential in lipid‐lowering drug treatment in the type 2 diabetes population: A Danish nationwide cohort study

“…Despite an increase over time in LLD use, studies have shown that patients with ASCVD (e.g. stroke, ischaemic heart disease and peripheral artery disease) remain, to a significant degree, undertreated 36‐38 …”

Adherence to Recommendations For Secondary Prevention Medications After Myocardial Infarction in Estonia – Comparison of Real-World Data From 2004-2005 and 2017-2018

“…It is common practice that physicians are cautious when prescribing secondary prevention medications to elderly patients with the concerns of possible adverse effects, drug-drug interactions and questionable bene t in mind (15)(16)(17). Recently evidence has shown that elderly patients do bene t from guideline recommended secondary prevention drug therapy after MI without any substantial additional harm (18)(19)(20)(21).…”

“…So, the actual usage is probably lower than the presented results. But still, accounting reimbursed prescriptions as used medications by patient is a validated methodology (17).…”