Annals of Internal MedicineBenefits and Risks Associated with Statin Therapy for Primary Prevention in Old and Very Old Adults: Real-World Evidence From a Target Trial Emulation Study

Real-world data reveals that statin therapy reduces cardiovascular events in older adults without increasing severe adverse effects, suggesting broader applicability in primary prevention for this age group.

Statin therapy’s role in primary prevention of cardiovascular diseases (CVDs) and all-cause mortality in adults aged 75 years or older remains debated due to insufficient representation in randomized controlled trials. This study investigates the benefits and risks of statin use in old (75-84 years) and very old (85+ years) adults, utilizing a target trial emulation approach to offer real-world evidence from Hong Kong’s electronic medical records.

Study Design:

• Participants: Persons aged 75 years or older without preexisting diagnosed CVDs, drawn from Hong Kong’s territory-wide public electronic medical records between January 2008 and December 2015.
• Cohorts: 69,981 individuals aged 75-84 years and 14,555 individuals aged 85+ years met the inclusion criteria. Among these, 41,884 and 9,457 had a history of CHD equivalents (eg, diabetes) in their respective age groups.
• Intervention: Initiation of statin therapy.
• Outcome Measures: Incidence of major CVDs (stroke, myocardial infarction, or heart failure), all-cause mortality, and major adverse events (myopathies and liver dysfunction).

Key Findings:

• CVD Incidence: Statin therapy was associated with a reduced risk of overall CVD incidence in adults aged 75-84 years (5-year standardized risk reduction: ITT 1.20%, PP 5.00%) and in those aged 85+ years (ITT 4.44%, PP 12.50%).
• Adverse Events: No significant increase in risks for myopathies and liver dysfunction was observed in either age group.
• Follow-up Period: Average follow-up duration was 5.3 years, with 9,676 CVD cases in the 75-84 years group and 1,600 in the 85+ years group.

HCN Medical Memo
Statin therapy for primary prevention in adults aged 75 years and older appears beneficial in reducing the incidence of major cardiovascular events without increasing the risk of severe adverse effects. This study provides important evidence supporting the use of statins in older populations, addressing a critical gap in clinical guidelines and offering practical insights for managing cardiovascular risk in elderly patients.

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