Statins for Primary Prevention of Cardiovascular Events and Mortality in Older Men

• Autores: Ariela R. Orkaby, J. Michael Gaziano, Luc Djoussé, Jane A. Driver
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 65, Nº. 11, 2017, págs. 2362-2368
• Idioma: inglés
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• Resumen

  • Background/Objectives We sought to determine whether statin use for primary prevention is associated with a lower risk of cardiovascular events or mortality in older men.

    Design Prospective cohort study.

    Setting Physicians’ Health Study participants.

    Participants 7,213 male physicians ≥70 years without a history of cardiovascular disease (CVD).

    Measurements Multivariable propensity score for statin use with greedy matching (1:1) to minimize confounding by indication.

    Results Median baseline age was 77 (70–102), median follow-up was 7 years. Non-users were matched to 1,130 statin users. Statin use was associated with an 18% lower risk of all-cause mortality, HR 0.82 (95% CI 0.69–0.98) and non-significant lower risk of CVD events, HR 0.86 (95% CI 0.70–1.06) and stroke, HR 0.70 (95% CI 0.45–1.09). In subgroup analyses, results did not change according to age group at baseline (70–76 or >76 years) or functional status. There was a suggestion that those >76 at baseline did not benefit from statins for mortality, HR 1.14 (95% CI 0.89–1.47), compared to those 70–76 at baseline, HR 0.83 (95% CI 0.61–1.11); however the CIs overlap between the two groups, suggesting no difference. Statin users with elevated total cholesterol had fewer major CVD events than non-users, HR 0.68 (95% CI 0.50–0.94) and HR 1.43 (95% CI 0.99–2.07)), respectively.

    Conclusions Statin use was associated with a significant lower risk of mortality in older male physicians ≥70 and a nonsignificant lower risk of CVD events. Results did not change in those who were >76 years at baseline or according to functional status. There was a suggestion that those with elevated total cholesterol may benefit. Further work is needed to determine which older individuals will benefit from statins as primary prevention.