Statins vs usual care for primary cardiovascular prevention in older adults

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Data showed that statin therapy for primary cardiovascular prevention may not benefit adults older than 65 years of age.
Data showed that statin therapy for primary cardiovascular prevention may not benefit adults older than 65 years of age.

Statin therapy did not show benefit in the primary prevention for all-cause mortality or coronary heart disease events in adults older than 65 years of age, according to a study published in JAMA Internal Medicine.

Researchers conducted the Lipid-Lowering Trial (LLT) component of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT) to examine statin treatment used for primary prevention in adults older than 65 years of age.

A total of 2,867 ambulatory adults with hypertension and without atherosclerotic cardiovascular disease were included in the study. The participants were assigned to receive either 40 mg/d of pravastatin sodium (n=1,467) or usual care (n=1,400).

The primary outcome of the trial was all-cause mortality, and secondary outcomes included cause-specific mortality and nonfatal myocardial infarction or fatal coronary heart disease.

The baseline mean low-density lipoprotein (LDL) cholesterol levels were 147.7 mg/dL in the pravastatin group and 147.6 mg/dL in the usual care group. By 6 years, the LDL cholesterol levels decreased to 109.1 mg/dL in the pravastatin group and 128.8 mg/dL in the usual care group. At 6 years, 16.6% of participants assigned to pravastatin were not taking any statin, and 71.0% of the participants assigned to the usual care group were not taking any statin.

The hazard ratios for all-cause mortality in the pravastatin group compared with the usual care group were 1.18 for adults older than 65 years of age, 1.08 for adults between 65 and 74 years of age, and 1.34 for adults older than 75 years of age.

The researchers note that coronary heart disease event rates were not significantly different among the groups. In addition, they observed a nonsignificant direction toward increased all-cause mortality with pravastatin in adults older than 75 years of age.

“The ALLHAT-LLT data suggest that, while there may be a trend toward cardiovascular benefit, there was no all-cause mortality benefit of statins for adults 65 years and older,” the study authors concluded.

Reference

  1. Han BH, Sutin D, Williamson JD, et al. Effect of statin treatment vs usual care on primary cardiovascular prevention among older adults: The ALLHAT-LLT randomized clinical trial. JAMA Intern Med. 2017. doi:10.1001/jamainternmed.2017.1442
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