BACKGROUND: Evidence to guide primary prevention in adults aged 75 years or older is limited. OBJECTIVE: To project the population impact and cost-effectiveness of statin therapy in adults aged 75 years or older. DESIGN: Forecasting study using the Cardiovascular Disease Policy Model, a Markov model. DATA SOURCES: Trial, cohort, and nationally representative data sources. TARGET POPULATION: U.S. adults aged 75 to 94 years. TIME HORIZON: 10 years. PERSPECTIVE: Health care system. INTERVENTION: Statins for primary prevention based on low-density lipoprotein cholesterol threshold of 4.91 mmol/L (190 mg/dL), 4.14 mmol/L (160 mg/dL), or 3.36 mmol/L (130 mg/dL); presence of diabetes; or 10-year risk score of at least 7.5%. OUTCOME MEASURES: Myocardial infarction (MI), coronary heart disease (CHD) death, disability-adjusted life-years, and costs. RESULTS OF BASE-CASE ANALYSIS: All adults aged 75 years or older in the National Health and Nutrition Examination Survey have a 10-year risk score greater than 7.5%. If statins had no effect on functional limitation or cognitive impairment, all primary prevention strategies would prevent MIs and CHD deaths and be cost-effective. Treatment of all adults aged 75 to 94 years would result in 8 million additional users and prevent 105 000 (4.3%) incident MIs and 68 000 (2.3%) CHD deaths at an incremental cost per disability-adjusted life-year of $25 200. RESULTS OF SENSITIVITY ANALYSIS: An increased relative risk for functional limitation or mild cognitive impairment of 1.10 to 1.29 could offset the cardiovascular benefits. LIMITATION: Limited trial evidence targeting primary prevention in adults aged 75 years or older. CONCLUSION: At effectiveness similar to that in trials, statins are projected to be cost-effective for primary prevention; however, even a small increase in geriatric-specific adverse effects could offset the cardiovascular benefit. Improved data on the potential benefits and harms of statins are needed to inform decision making. PRIMARY FUNDING SOURCE: American Heart Association Western States Affiliate, National Institute on Aging, and the National Institute for Diabetes on Digestive and Kidney Diseases.
BACKGROUND: Evidence to guide primary prevention in adults aged 75 years or older is limited. OBJECTIVE: To project the population impact and cost-effectiveness of statin therapy in adults aged 75 years or older. DESIGN: Forecasting study using the Cardiovascular Disease Policy Model, a Markov model. DATA SOURCES: Trial, cohort, and nationally representative data sources. TARGET POPULATION: U.S. adults aged 75 to 94 years. TIME HORIZON: 10 years. PERSPECTIVE: Health care system. INTERVENTION: Statins for primary prevention based on low-density lipoprotein cholesterol threshold of 4.91 mmol/L (190 mg/dL), 4.14 mmol/L (160 mg/dL), or 3.36 mmol/L (130 mg/dL); presence of diabetes; or 10-year risk score of at least 7.5%. OUTCOME MEASURES: Myocardial infarction (MI), coronary heart disease (CHD) death, disability-adjusted life-years, and costs. RESULTS OF BASE-CASE ANALYSIS: All adults aged 75 years or older in the National Health and Nutrition Examination Survey have a 10-year risk score greater than 7.5%. If statins had no effect on functional limitation or cognitive impairment, all primary prevention strategies would prevent MIs and CHD deaths and be cost-effective. Treatment of all adults aged 75 to 94 years would result in 8 million additional users and prevent 105 000 (4.3%) incident MIs and 68 000 (2.3%) CHD deaths at an incremental cost per disability-adjusted life-year of $25 200. RESULTS OF SENSITIVITY ANALYSIS: An increased relative risk for functional limitation or mild cognitive impairment of 1.10 to 1.29 could offset the cardiovascular benefits. LIMITATION: Limited trial evidence targeting primary prevention in adults aged 75 years or older. CONCLUSION: At effectiveness similar to that in trials, statins are projected to be cost-effective for primary prevention; however, even a small increase in geriatric-specific adverse effects could offset the cardiovascular benefit. Improved data on the potential benefits and harms of statins are needed to inform decision making. PRIMARY FUNDING SOURCE: American Heart Association Western States Affiliate, National Institute on Aging, and the National Institute for Diabetes on Digestive and Kidney Diseases.
Authors: A W Weverling-Rijnsburger; G J Blauw; A M Lagaay; D L Knook; A E Meinders; R G Westendorp Journal: Lancet Date: 1997-10-18 Impact factor: 79.321
Authors: Matthew F Muldoon; Christopher M Ryan; Susan M Sereika; Janine D Flory; Stephen B Manuck Journal: Am J Med Date: 2004-12-01 Impact factor: 4.965
Authors: Mark J Pletcher; Lawrence Lazar; Kirsten Bibbins-Domingo; Andrew Moran; Nicolas Rodondi; Pamela Coxson; James Lightwood; Lawrence Williams; Lee Goldman Journal: Ann Intern Med Date: 2009-02-17 Impact factor: 25.391
Authors: Brie A Williams; Amanda Li; Cyrus Ahalt; Pamela Coxson; James G Kahn; Kirsten Bibbins-Domingo Journal: J Gen Intern Med Date: 2019-10 Impact factor: 5.128
Authors: Benjamin H Han; David Sutin; Jeff D Williamson; Barry R Davis; Linda B Piller; Hannah Pervin; Sara L Pressel; Caroline S Blaum Journal: JAMA Intern Med Date: 2017-07-01 Impact factor: 21.873
Authors: Sonal Singh; Susan Zieman; Alan S Go; Stephen P Fortmann; Nanette K Wenger; Jerome L Fleg; Barbara Radziszewska; Neil J Stone; Sophia Zoungas; Jerry H Gurwitz Journal: J Am Geriatr Soc Date: 2018-10-02 Impact factor: 5.562
Authors: Nathalie Moise; Chen Huang; Anthony Rodgers; Ciaran N Kohli-Lynch; Keane Y Tzong; Pamela G Coxson; Kirsten Bibbins-Domingo; Lee Goldman; Andrew E Moran Journal: Hypertension Date: 2016-05-15 Impact factor: 10.190