In the Journals

Statin use does not alter CVD event rates in older adults

The rate of primary CVD events did not differ among older adults taking statins vs. those not taking statins at baseline, according to a new study published in JAMA Internal Medicine.

Debate continues about the benefits and risks of statins for primary prevention, especially among older adults,” Marco D. Huesch, MBBS, PhD, from the department of radiology at the Penn State Milton S. Hershey Medical Center, wrote. “Recently, older adults with moderate hyperlipidemia and hypertension who were randomized to initiate statin therapy for primary prevention, instead of receiving usual care, experienced no benefit.”

Huesch noted that patients who were already taking statins were not included in the trial, which could potentially alter results if such patients were at higher risk for CVD. Therefore, he reassessed data from the Systolic Blood Pressure Intervention Trial (SPRINT) to better determine the effect of statins without potential exclusion bias.

Participants younger than 70 years and those with baseline diagnosed clinical CVD were excluded from the analysis. The study was controlled for baseline age, sex, race, smoking status, systolic and diastolic BP, number of BP agents, aspirin use, glucose, cholesterol, HDL cholesterol, triglycerides, serum creatinine, estimated glomerular filtration rate, ratio of urine albumin to creatinine, and BP management randomization.

A total of 3,054 participants from the SPRINT trial were 70 years or older and 1,350 were taking statins at baseline. A substantially lower Framingham 10-year risk of CVD was observed in participants on statins, compared with those not on statins. However, participants who were taking statins had a greater likelihood of being male, having chronic kidney disease and having a higher BMI and higher glucose. Primary event rates did not differ among participants with or without statin use at baseline (0.064 vs. 0.078; absolute rate reduction = 0.014).

The average event rate was 0.063 for patients aged 70 years or older who used statins at baseline and 0.081 for those who did not use statins (absolute rate reduction = 0.018). The average time to event was 669.2 days for patients who used statins at baseline and 735.8 days for those who did not use statins.

These results were not modified when changing the age threshold to 65 years and older, according to Huesch.

“We still do not have sufficient numbers of primary prevention trials to make strong recommendations about statins in intermediate-risk populations (6%-12% 10-year risk), at least on the basis of survival,” Huesch concluded. “Yet even in this relatively high-risk older adult population (22%-25% 10-year risk), significant reductions in cardiovascular events were not found.”

In May 2017, Healio Internal Medicine spoke with several experts who emphasized that prevention and even reversal of heart disease is attainable through substantial diet and lifestyle changes as an effective alternative to statins for cardiovascular diseases. – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.

The rate of primary CVD events did not differ among older adults taking statins vs. those not taking statins at baseline, according to a new study published in JAMA Internal Medicine.

Debate continues about the benefits and risks of statins for primary prevention, especially among older adults,” Marco D. Huesch, MBBS, PhD, from the department of radiology at the Penn State Milton S. Hershey Medical Center, wrote. “Recently, older adults with moderate hyperlipidemia and hypertension who were randomized to initiate statin therapy for primary prevention, instead of receiving usual care, experienced no benefit.”

Huesch noted that patients who were already taking statins were not included in the trial, which could potentially alter results if such patients were at higher risk for CVD. Therefore, he reassessed data from the Systolic Blood Pressure Intervention Trial (SPRINT) to better determine the effect of statins without potential exclusion bias.

Participants younger than 70 years and those with baseline diagnosed clinical CVD were excluded from the analysis. The study was controlled for baseline age, sex, race, smoking status, systolic and diastolic BP, number of BP agents, aspirin use, glucose, cholesterol, HDL cholesterol, triglycerides, serum creatinine, estimated glomerular filtration rate, ratio of urine albumin to creatinine, and BP management randomization.

A total of 3,054 participants from the SPRINT trial were 70 years or older and 1,350 were taking statins at baseline. A substantially lower Framingham 10-year risk of CVD was observed in participants on statins, compared with those not on statins. However, participants who were taking statins had a greater likelihood of being male, having chronic kidney disease and having a higher BMI and higher glucose. Primary event rates did not differ among participants with or without statin use at baseline (0.064 vs. 0.078; absolute rate reduction = 0.014).

The average event rate was 0.063 for patients aged 70 years or older who used statins at baseline and 0.081 for those who did not use statins (absolute rate reduction = 0.018). The average time to event was 669.2 days for patients who used statins at baseline and 735.8 days for those who did not use statins.

These results were not modified when changing the age threshold to 65 years and older, according to Huesch.

“We still do not have sufficient numbers of primary prevention trials to make strong recommendations about statins in intermediate-risk populations (6%-12% 10-year risk), at least on the basis of survival,” Huesch concluded. “Yet even in this relatively high-risk older adult population (22%-25% 10-year risk), significant reductions in cardiovascular events were not found.”

In May 2017, Healio Internal Medicine spoke with several experts who emphasized that prevention and even reversal of heart disease is attainable through substantial diet and lifestyle changes as an effective alternative to statins for cardiovascular diseases. – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.