Ariela R Orkaby1,2, J Michael Gaziano1,2,3, Luc Djousse1,2,3, Jane A Driver1,2. 1. Geriatric Research, Education, and Clinical Center (GRECC) and Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA. 2. Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 3. Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND/ OBJECTIVES: We sought to determine whether statin use for primary prevention is associated with a lower risk of cardiovascular events or mortality in older men. DESIGN: Prospective cohort study. SETTING: Physicians' Health Study participants. PARTICIPANTS: 7,213 male physicians ≥70 years without a history of cardiovascular disease (CVD). MEASUREMENTS: Multivariable propensity score for statin use with greedy matching (1:1) to minimize confounding by indication. RESULTS: Median baseline age was 77 (70-102), median follow-up was 7 years. Non-users were matched to 1,130 statin users. Statin use was associated with an 18% lower risk of all-cause mortality, HR 0.82 (95% CI 0.69-0.98) and non-significant lower risk of CVD events, HR 0.86 (95% CI 0.70-1.06) and stroke, HR 0.70 (95% CI 0.45-1.09). In subgroup analyses, results did not change according to age group at baseline (70-76 or >76 years) or functional status. There was a suggestion that those >76 at baseline did not benefit from statins for mortality, HR 1.14 (95% CI 0.89-1.47), compared to those 70-76 at baseline, HR 0.83 (95% CI 0.61-1.11); however the CIs overlap between the two groups, suggesting no difference. Statin users with elevated total cholesterol had fewer major CVD events than non-users, HR 0.68 (95% CI 0.50-0.94) and HR 1.43 (95% CI 0.99-2.07)), respectively. CONCLUSIONS: Statin use was associated with a significant lower risk of mortality in older male physicians ≥70 and a nonsignificant lower risk of CVD events. Results did not change in those who were >76 years at baseline or according to functional status. There was a suggestion that those with elevated total cholesterol may benefit. Further work is needed to determine which older individuals will benefit from statins as primary prevention.
BACKGROUND/ OBJECTIVES: We sought to determine whether statin use for primary prevention is associated with a lower risk of cardiovascular events or mortality in older men. DESIGN: Prospective cohort study. SETTING: Physicians' Health Study participants. PARTICIPANTS: 7,213 male physicians ≥70 years without a history of cardiovascular disease (CVD). MEASUREMENTS: Multivariable propensity score for statin use with greedy matching (1:1) to minimize confounding by indication. RESULTS: Median baseline age was 77 (70-102), median follow-up was 7 years. Non-users were matched to 1,130 statin users. Statin use was associated with an 18% lower risk of all-cause mortality, HR 0.82 (95% CI 0.69-0.98) and non-significant lower risk of CVD events, HR 0.86 (95% CI 0.70-1.06) and stroke, HR 0.70 (95% CI 0.45-1.09). In subgroup analyses, results did not change according to age group at baseline (70-76 or >76 years) or functional status. There was a suggestion that those >76 at baseline did not benefit from statins for mortality, HR 1.14 (95% CI 0.89-1.47), compared to those 70-76 at baseline, HR 0.83 (95% CI 0.61-1.11); however the CIs overlap between the two groups, suggesting no difference. Statin users with elevated total cholesterol had fewer major CVD events than non-users, HR 0.68 (95% CI 0.50-0.94) and HR 1.43 (95% CI 0.99-2.07)), respectively. CONCLUSIONS: Statin use was associated with a significant lower risk of mortality in older male physicians ≥70 and a nonsignificant lower risk of CVD events. Results did not change in those who were >76 years at baseline or according to functional status. There was a suggestion that those with elevated total cholesterol may benefit. Further work is needed to determine which older individuals will benefit from statins as primary prevention.
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