Statins for primary prevention in adults aged 75 years and older: A nationwide population-based case-control study

Abstract

Background and aims: There is inadequate evidence to establish statin treatment for primary prevention in the elderly. This study evaluated whether statins are beneficial for primary prevention of cardiovascular disease (CVD) and all-cause death in adults aged ≥ 75 years.

Methods: A nationwide, nested case-control study was conducted in Korea. Individuals who developed CVD, including myocardial infarction (MI), stroke, or death from all causes, were matched to controls based on duration of follow-up, age, and sex at the index date. The statin administration data from both groups were retrospectively collected from the index date to five years before. Odds ratios (ORs) and 95% confidence intervals (CIs) for composite and individual outcomes associated with statin treatment were estimated by conditional logistic regression analyses.

Results: In total, 11,017 cases were matched to 55,085 control subjects. Current use of statins was significantly associated with a reduced risk of composite outcome (adjusted OR [AOR] 0.77; 95% CI 0.71-0.84), compared with non-users. Current use of statin also reduced the risk of stroke (AOR 0.74; 95% CI 0.61-0.89) and of all-cause death (AOR 0.73; 95% CI 0.66-0.81), but not of MI. However, former use of statins had no effect on CVD or all-cause death. There were significant decreasing trends in the incidence of composite outcomes and individual stroke or all-cause death with longer duration of statin treatment.

Conclusions: Current statin treatment has a beneficial effect as primary prevention for composite outcomes and individual event of stroke or all-cause death in Koreans aged ≥75 years.

Keywords: Cardiovascular disease; Case and control study; Elderly; Mortality; Statin.