The aggregate cardiovascular benefits of LDL-lowering with statins (HMG-CoA reductase inhibitors) for primary prevention have been well established in the general population. However, debate continues about whether this relationship exists in subgroups, such as women and the elderly. Currently, the use of statins for elderly patients (≥65 years) without a history of a previous cardiovascular event is a Class IIB recommendation in the European Society of Cardiology guidelines for prevention. This designation is based on the absence of dedicated randomized controlled trial data in this population.
For this reason, an Italian group (Savarese et al) recently undertook a large meta-analysis (8 clinical trials totaling 24,674 patients) to determine whether statins are effective in reducing adverse cardiovascular events in the elderly. Within the study cohort, there was a relatively even distribution between those randomized to statin therapy (n=12,292) and those those randomized to placebo (n=12,382); 43% were female and the mean age was 73 years; mean follow-up time was 3.5 ± 1.5 years.
The results, published in August in the Journal of the American College of Cardiology, confirmed that statins did indeed reduce the incidence of myocardial infarction (MI) by 39.4% and the risk of stroke by 23.8% in elderly patients. Unlike the effect of this class of drugs in the general population, however, use of statins did not result in a statistically significant reduction in all-cause mortality or cardiovascular mortality (although there was a non-significant 6% and 9% reduction, respectively). Study limitations include those common among meta-analyses, such as an inability to analyze individual-level data, the relatively short follow-up, and the lack of ability to stratify results by intensity of statin.
The findings, nonetheless, suggest that the use of statins for primary prevention in elderly patients result in a significant reduction in MI and stroke and ought to be considered by primary care practitioners in those patients who are at low risk for adverse effects from statin therapy.
Savarese G, Gotto AM Jr, Paolillo S, et al. Benefits of stains in elderly subjects without established cardiovascular disease: a metay-analysis. J Am Coll Cardiol. 2013 Aug 14; doi:10.1016/j.jacc.2013.07.069. (Epub ahead of print) (Abstract)