Oscar J Ponce1,2,3, Laura Larrea-Mantilla1,3, Bianca Hemmingsen4, Valentina Serrano3,5, Rene Rodriguez-Gutierrez3,6, Gabriela Spencer-Bonilla3,7, Neri Alvarez-Villalobos3,6, Khaled Benkhadra8, Abdullah Haddad9, Michael R Gionfriddo10, Larry J Prokop1, Juan P Brito3, Mohammad Hassan Murad1. 1. Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota. 2. Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru. 3. Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota. 4. Department of Internal Medicine, Herlev University Hospital, Herlev, Denmark. 5. Department of Nutrition, Diabetes and Metabolism, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile. 6. Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José E. Gonzalez," Plataforma INVEST-KER Mexico, Monterrey, Nuevo León, México. 7. University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico. 8. Department of Internal Medicine, School of Medicine, Wayne State University, Detroit, Michigan. 9. Department of Medicine, Saint Clair Memorial Hospital, Pittsburgh, Pennsylvania. 10. Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, Pennsylvania.
Abstract
BACKGROUND: The efficacy of lipid-lowering agents on patient-important outcomes in older individuals is unclear. METHODS: We included randomized trials that enrolled individuals aged 65 years or older and that included at least 1 year of follow-up.Pairs of reviewers selected and appraised the trials. RESULTS: We included 23 trials that enrolled 60,194 elderly patients. For primary prevention, statins reduced the risk of coronary artery disease [CAD; relative risk (RR): 0.79, 95% CI: 0.68 to 0.91] and myocardial infarction (MI; RR: 0.45, 95% CI: 0.31 to 0.66) but not all-cause or cardiovascular mortality or stroke. These effects were imprecise in patients with diabetes, but there was no significant interaction between diabetes status and the intervention effect. For secondary prevention, statins reduced all-cause mortality (RR: 0.80, 95% CI: 0.73 to 0.89), cardiovascular mortality (RR: 0.68, 95% CI: 0.58 to 0.79), CAD (RR: 0.68, 95% CI: 0.61 to 0.77), MI (RR: 0.68, 95% CI: 0.59 to 0.79), and revascularization (RR: 0.68, 95% CI: 0.61 to 0.77). Intensive (vs less-intensive) statin therapy reduced the risk of CAD and heart failure. Niacin did not reduce the risk of revascularization, and fibrates did not reduce the risk of stroke, cardiovascular mortality, or CAD. CONCLUSION: High-certainty evidence supports statin use for secondary prevention in older individuals. Evidence for primary prevention is less certain. Data in older individuals with diabetes are limited; however, no empirical evidence has shown a significant difference based on diabetes status.
BACKGROUND: The efficacy of lipid-lowering agents on patient-important outcomes in older individuals is unclear. METHODS: We included randomized trials that enrolled individuals aged 65 years or older and that included at least 1 year of follow-up.Pairs of reviewers selected and appraised the trials. RESULTS: We included 23 trials that enrolled 60,194 elderly patients. For primary prevention, statins reduced the risk of coronary artery disease [CAD; relative risk (RR): 0.79, 95% CI: 0.68 to 0.91] and myocardial infarction (MI; RR: 0.45, 95% CI: 0.31 to 0.66) but not all-cause or cardiovascular mortality or stroke. These effects were imprecise in patients with diabetes, but there was no significant interaction between diabetes status and the intervention effect. For secondary prevention, statins reduced all-cause mortality (RR: 0.80, 95% CI: 0.73 to 0.89), cardiovascular mortality (RR: 0.68, 95% CI: 0.58 to 0.79), CAD (RR: 0.68, 95% CI: 0.61 to 0.77), MI (RR: 0.68, 95% CI: 0.59 to 0.79), and revascularization (RR: 0.68, 95% CI: 0.61 to 0.77). Intensive (vs less-intensive) statin therapy reduced the risk of CAD and heart failure. Niacin did not reduce the risk of revascularization, and fibrates did not reduce the risk of stroke, cardiovascular mortality, or CAD. CONCLUSION: High-certainty evidence supports statin use for secondary prevention in older individuals. Evidence for primary prevention is less certain. Data in older individuals with diabetes are limited; however, no empirical evidence has shown a significant difference based on diabetes status.
Authors: Lidia Cobos-Palacios; Jaime Sanz-Cánovas; Mónica Muñoz-Ubeda; María Dolores Lopez-Carmona; Luis Miguel Perez-Belmonte; Almudena Lopez-Sampalo; Ricardo Gomez-Huelgas; Maria Rosa Bernal-Lopez Journal: Front Cardiovasc Med Date: 2021-11-29
Authors: Kamal Awad; Maged Mohammed; Mahmoud Mohamed Zaki; Abdelrahman I Abushouk; Gregory Y H Lip; Michael J Blaha; Carl J Lavie; Peter P Toth; J Wouter Jukema; Naveed Sattar; Maciej Banach Journal: BMC Med Date: 2021-06-22 Impact factor: 8.775