Appropriateness of statins in patients aged ≥80 years and comparison to other age groups

Abstract

In patients aged ≥80 years without previous coronary artery disease, peripheral vascular disease, or cerebrovascular disease, no evidence has shown a benefit from statin therapy. We examined the prevalence of statin use in patients aged ≥80 years for the indication of primary prevention. We reviewed the comprehensive electronic health records at the Geisinger Health System in Pennsylvania for all patients aged >55 years with ≥1 primary care encounter from January 24, 2004 and December 31, 2009. The records were scrutinized for the use of a statin, active medical diagnoses, and laboratory values. Patients without a previous diagnosis of coronary artery disease, peripheral vascular disease, or cerebrovascular disease were considered to have a primary prevention indication for statin therapy. The prevalence of statin use was examined, and a multivariate analysis was conducted to determine the predictors of use. A total of 89,086 patients were included in the analysis, with 22,646 patients aged ≥80 years. Of all the patients, 26% were prescribed a statin, of whom, 71% (n = 16,687) received it for primary prevention. Of the 14,604 patients aged ≥80 years with a primary prevention indication, 3,145 (22%) received a statin. A plot of 5-year age cohorts from 55 to >90 years demonstrated an n-shaped relation between age and statin use for primary prevention (18%, 23%, 27%, 29%, 28%, 26%, 21%, and 12%, p <0.001). Compared to patients aged <65 years, the ratio of statin prescription for secondary to primary prevention was 31% lower in patients aged ≥80 years (1.3 vs 1.9). Those aged ≥80 years with a primary prevention indication had, with treatment, a mean low-density lipoprotein level of 84 ± 26 mg/dl. In conclusion, many patients aged ≥80 years receive statin therapy for primary prevention and are treated to aggressive low-density lipoprotein levels. Because the efficacy is uncertain and the potential adverse effects are many, we urgently need to define the cost, benefit, and risk of statin use in the very elderly.