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Am Fam Physician. 2019;99(7):461

Clinical Question

In older persons without a history of cardiovascular disease (CVD), is statin treatment associated with better outcomes?

Bottom Line

In this retrospective study, statin treatment in patients 75 years or older without preexisting CVD did not change the likelihood of developing CVD or reduce any-cause mortality. However, patients 75 to 84 years of age with diabetes mellitus benefitted from treatment. These results support the results from the ALLHAT study. (Level of Evidence = 2b)

Synopsis

This study enrolled 46,864 patients 75 years or older with no CVD from a population database in Spain. The patients were an average age of 76 years (63% were women) and were followed up for an average of 5.6 years. Of these, 6,550 patients began statin treatment in the 18 months before the start of the study. In participants without diabetes there was no difference in the onset of CVD (hazard ratio [HR] = 0.94; 95% CI, 0.86 to 1.04) or the rate of mortality due to any reason (HR = 0.98; CI, 0.91 to 1.05). In patients 85 years or older, there also was no reduction in the likelihood of CVD (HR = 0.93; CI, 0.82 to 1.06) or all-cause mortality (HR = 0.97; CI, 0.90 to 1.05), However, in patients with diabetes who were between 75 and 84 years of age, the likelihood of developing CVD was reduced (HR = 0.76; CI, 0.65 to 0.89). All-cause mortality was decreased over an average of 5.6 years, with one additional person alive for every 16 persons treated with a statin (number needed to treat = 15.63; CI, 9.5 to 49.6). The difference was not significant for any patients 85 years or older.

Study design: Cohort (retrospective)

Funding source: Government

Setting: Population-based

Reference: RamosRComas-CufíMMartí-LluchRet alStatins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study. BMJ2018;362:k3359.

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