Ok Sang Lee1,2, Jinlong Zhang3, Sun-Hoi Jung1, Hyang-Sook Kim1, Myung-Koo Lee2, Hae-Young Lee3. 1. Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea. 2. College of Pharmacy, Chungbuk National University, Cheongju, Republic of Korea. 3. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Abstract
PURPOSE: Although moderate- to high-intensity statin therapy is increasingly recommended in cardiovascular disease patients, the efficacy and safety in elderly patients have not been proven clearly. Here, we compare the effect of various-intensity statins between elderly and very elderly patients. METHODS: 43,870 patients over 65 years old who were treated with statins were screened using electronic medical record data. RESULTS: We evaluated 451 patients in the elderly group aged 65-74 years and 159 patients in the very elderly group over 75 years old. Baseline cholesterol profiles were similar between the 2 groups, but the 10-year atherosclerotic cardiovascular disease (ASCVD) risk was significantly higher in the very elderly (20.9 ± 11.5$ vs. 37.2 ± 13.6$, p < 0.001). The reduction rate of low-density lipoprotein (LDL) (-40.2 ± 21.3$ vs. -39.3 ± 21.0$, p = 0.634) and the ratio of target LDL attainment (74.2 vs. 79.2$, p = 0.252) were similar between the 2 groups. Low-intensity statins showed comparable LDL cholesterol reduction with moderate-intensity statins both in the elderly and the very elderly groups. The 10-year ASCVD risk reduction was similar between the 2 groups (-3.5 ± 4.9$ vs. -3.0 ± 8.4$, p = 0.480), but in the very elderly group, no different ASCVD reduction rate was shown in low- to high-intensity statins (p = 0.784). Only the elderly group showed a significant correlation (r = 0.112, p = 0.017) with LDL reduction and 10-year ASCVD risk. Interestingly, the incidence of adverse drug reaction (ADR) was higher in the very elderly group (4.4$) than in the elderly group (2.7$) and was more frequent in high-intensity statin therapy. CONCLUSION: The efficacy of statins in LDL reduction was similar between the elderly and very elderly population. However, the benefit of moderate- to high-intensity statins is limited considering potential ADR. Therefore, the stepwise intensification of statin therapy might be necessary for the very elderly in spite of the higher cardiovascular risk.
PURPOSE: Although moderate- to high-intensity statin therapy is increasingly recommended in cardiovascular disease patients, the efficacy and safety in elderly patients have not been proven clearly. Here, we compare the effect of various-intensity statins between elderly and very elderly patients. METHODS: 43,870 patients over 65 years old who were treated with statins were screened using electronic medical record data. RESULTS: We evaluated 451 patients in the elderly group aged 65-74 years and 159 patients in the very elderly group over 75 years old. Baseline cholesterol profiles were similar between the 2 groups, but the 10-year atherosclerotic cardiovascular disease (ASCVD) risk was significantly higher in the very elderly (20.9 ± 11.5$ vs. 37.2 ± 13.6$, p < 0.001). The reduction rate of low-density lipoprotein (LDL) (-40.2 ± 21.3$ vs. -39.3 ± 21.0$, p = 0.634) and the ratio of target LDL attainment (74.2 vs. 79.2$, p = 0.252) were similar between the 2 groups. Low-intensity statins showed comparable LDL cholesterol reduction with moderate-intensity statins both in the elderly and the very elderly groups. The 10-year ASCVD risk reduction was similar between the 2 groups (-3.5 ± 4.9$ vs. -3.0 ± 8.4$, p = 0.480), but in the very elderly group, no different ASCVD reduction rate was shown in low- to high-intensity statins (p = 0.784). Only the elderly group showed a significant correlation (r = 0.112, p = 0.017) with LDL reduction and 10-year ASCVD risk. Interestingly, the incidence of adverse drug reaction (ADR) was higher in the very elderly group (4.4$) than in the elderly group (2.7$) and was more frequent in high-intensity statin therapy. CONCLUSION: The efficacy of statins in LDL reduction was similar between the elderly and very elderly population. However, the benefit of moderate- to high-intensity statins is limited considering potential ADR. Therefore, the stepwise intensification of statin therapy might be necessary for the very elderly in spite of the higher cardiovascular risk.
Entities:
Keywords:
Adverse drug reaction; Cardiovascular disease; Cholesterol; Elderly; Statins
Authors: David C Goff; Donald M Lloyd-Jones; Glen Bennett; Sean Coady; Ralph B D'Agostino; Raymond Gibbons; Philip Greenland; Daniel T Lackland; Daniel Levy; Christopher J O'Donnell; Jennifer G Robinson; J Sanford Schwartz; Susan T Shero; Sidney C Smith; Paul Sorlie; Neil J Stone; Peter W F Wilson; Harmon S Jordan; Lev Nevo; Janusz Wnek; Jeffrey L Anderson; Jonathan L Halperin; Nancy M Albert; Biykem Bozkurt; Ralph G Brindis; Lesley H Curtis; David DeMets; Judith S Hochman; Richard J Kovacs; E Magnus Ohman; Susan J Pressler; Frank W Sellke; Win-Kuang Shen; Sidney C Smith; Gordon F Tomaselli Journal: Circulation Date: 2013-11-12 Impact factor: 29.690
Authors: Zeljko Reiner; Alberico L Catapano; Guy De Backer; Ian Graham; Marja-Riitta Taskinen; Olov Wiklund; Stefan Agewall; Eduardo Alegria; M John Chapman; Paul Durrington; Serap Erdine; Julian Halcox; Richard Hobbs; John Kjekshus; Pasquale Perrone Filardi; Gabriele Riccardi; Robert F Storey; David Wood Journal: Eur Heart J Date: 2011-06-28 Impact factor: 29.983
Authors: Tessa K Morgan; Margaret Williamson; Marie Pirotta; Kay Stewart; Stephen P Myers; Joanne Barnes Journal: Med J Aust Date: 2012-01-16 Impact factor: 7.738
Authors: Helen M Colhoun; D John Betteridge; Paul N Durrington; Graham A Hitman; H Andrew W Neil; Shona J Livingstone; Margaret J Thomason; Michael I Mackness; Valentine Charlton-Menys; John H Fuller Journal: Lancet Date: 2004 Aug 21-27 Impact factor: 79.321
Authors: J Shepherd; S M Cobbe; I Ford; C G Isles; A R Lorimer; P W MacFarlane; J H McKillop; C J Packard Journal: N Engl J Med Date: 1995-11-16 Impact factor: 91.245