Older vs. younger adults derive more benefit from statins
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Key takeaways:
- Statin treatment was associated with greater LDL reduction among older vs. younger adults.
- The association persisted among primary and secondary prevention patients, and for those with diabetes.
Older adults derive greater LDL benefits after initiating statin therapy compared with younger adults, regardless of whether statins are prescribed for primary or secondary prevention or to people with diabetes, researchers reported.
Current guidelines recommend statin use for secondary prevention in older adults, but the recommendation is less strong for primary prevention, Marie Lund, MD, PhD, staff specialist at the department of clinical pharmacology at Bispebjerg and Frederiksberg Hospital, a researcher at Statens Serum Institut and clinical associate professor at the University of Copenhagen, and colleagues wrote in the study background.
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“Older patients have been underrepresented in randomized clinical trials of statins, so evidence is limited in this age group,” Lund told Healio. “There is also more concern about potential adverse events in older individuals, and adverse events increase with higher statin doses. Our study used national data from routine clinical practice and is more representative than data from randomized clinical trials, in which the participants are generally younger and have less comorbidity.”
Lund and colleagues used unique Danish nationwide registers to study an unselected cohort of 82,958 adults who initiated simvastatin or atorvastatin therapy during routine clinical practice from January 2008 to March 2018. LDL measurements were assessed before and during statin use. Within the cohort, 13% of adults were aged at least 75 years, 42% had a history of CVD, 8% had a history of diabetes without a history of CVD (diabetes cohort) and 50% were primary prevention patients. Researchers assessed the association between age and change in LDL.
The findings were published in Annals of Internal Medicine.
Researchers found that the observed percentage reduction in LDL was consistently lower for initiators of simvastatin younger than 50 years than for initiators aged at least 75 years (28.7% vs. 33.4% for 10 mg; 33.8% vs. 39% for 20 mg; and 38.6% vs. 42.2% for 40 mg). Similarly, the percentage reduction in LDL was also lower for initiators of atorvastatin younger than 50 years than for initiators aged at least 75 years among those prescribed a moderate-intensity dose (35.7% vs. 39.8% for 10 mg and 40.2% vs. 44.2% for 20 mg).
The adjusted percentage reduction differences for adults aged 75 years compared with initiators aged 50 years was 2.62 percentage points. This association was consistent for primary prevention (2.54 percentage points) and secondary prevention (2.32 percentage points) but smaller for initiators of high-intensity statins (atorvastatin, 40 mg: 1.36 percentage points; atorvastatin, 80 mg: –0.58 percentage points).
“Since older patients may expect a greater initial reduction in LDL cholesterol, our study suggests that starting a statin at low to moderate intensity is an appealing option in older persons who are at increased risk for adverse events,” Lund told Healio. “Adverse events are more frequent at higher statin doses and older persons are more susceptible to adverse events, so lower doses may be better tolerated and sufficiently effective. Current clinical guidelines suggest that decisions about statins in older persons also should consider factors such as estimated lifetime benefit, comorbidities, potential for drug-drug interactions and patient preferences — not just CV risk.”
For more information:
Marie Lund, MD, PhD, can be reached at mxd@ssi.dk.
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