Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study

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  • dc.contributor.author Ramos, Rafel
  • dc.contributor.author Comas Cufí, Marc
  • dc.contributor.author Martí, Ruth
  • dc.contributor.author Balló, Elisabeth
  • dc.contributor.author Ponjoan, Anna
  • dc.contributor.author Alves-Cabratosa, Lia
  • dc.contributor.author Blanch, Jordi
  • dc.contributor.author Marrugat de la Iglesia, Jaume
  • dc.contributor.author Elosua Llanos, Roberto
  • dc.contributor.author Grau Magaña, Maria
  • dc.contributor.author Elosua-Bayés, Marc
  • dc.contributor.author García-Ortiz, Luis
  • dc.contributor.author Garcia Gil, Maria
  • dc.date.accessioned 2019-03-19T08:32:27Z
  • dc.date.available 2019-03-19T08:32:27Z
  • dc.date.issued 2018
  • dc.description.abstract OBJECTIVE: To assess whether statin treatment is associated with a reduction in atherosclerotic cardiovascular disease (CVD) and mortality in old and very old adults with and without diabetes. DESIGN: Retrospective cohort study. SETTING: Database of the Catalan primary care system (SIDIAP), Spain, 2006-15. PARTICIPANTS: 46 864 people aged 75 years or more without clinically recognised atherosclerotic CVD. Participants were stratified by presence of type 2 diabetes mellitus and as statin non-users or new users. MAIN OUTCOME MEASURES: Incidences of atherosclerotic CVD and all cause mortality compared using Cox proportional hazards modelling, adjusted by the propensity score of statin treatment. The relation of age with the effect of statins was assessed using both a categorical approach, stratifying the analysis by old (75-84 years) and very old (≥85 years) age groups, and a continuous analysis, using an additive Cox proportional hazard model. RESULTS: The cohort included 46 864 participants (mean age 77 years; 63% women; median follow-up 5.6 years). In participants without diabetes, the hazard ratios for statin use in 75-84 year olds were 0.94 (95% confidence interval 0.86 to 1.04) for atherosclerotic CVD and 0.98 (0.91 to 1.05) for all cause mortality, and in those aged 85 and older were 0.93 (0.82 to 1.06) and 0.97 (0.90 to 1.05), respectively. In participants with diabetes, the hazard ratio of statin use in 75-84 year olds was 0.76 (0.65 to 0.89) for atherosclerotic CVD and 0.84 (0.75 to 0.94) for all cause mortality, and in those aged 85 and older were 0.82 (0.53 to 1.26) and 1.05 (0.86 to 1.28), respectively. Similarly, effect analysis of age in a continuous scale, using splines, corroborated the lack of beneficial statins effect for atherosclerotic CVD and all cause mortality in participants without diabetes older than 74 years. In participants with diabetes, statins showed a protective effect against atherosclerotic CVD and all cause mortality; this effect was substantially reduced beyond the age of 85 years and disappeared in nonagenarians. CONCLUSIONS: In participants older than 74 years without type 2 diabetes, statin treatment was not associated with a reduction in atherosclerotic CVD or in all cause mortality, even when the incidence of atherosclerotic CVD was statistically significantly higher than the risk thresholds proposed for statin use. In the presence of diabetes, statin use was statistically significantly associated with reductions in the incidence of atherosclerotic CVD and in all cause mortality. This effect decreased after age 85 years and disappeared in nonagenarians.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Ramos R, Comas-Cufí M, Martí-Lluch R, Balló E, Ponjoan A, Alves-Cabratosa L. et al. Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study. BMJ. 2018 Sep 5;362:k3359. DOI: 10.1136/bmj.k3359
  • dc.identifier.doi http://dx.doi.org/10.1136/bmj.k3359
  • dc.identifier.issn 0959-8138
  • dc.identifier.uri http://hdl.handle.net/10230/36860
  • dc.language.iso eng
  • dc.publisher BMJ Publishing Group
  • dc.relation.ispartof BMJ. 2018 Sep 5;362:k3359
  • dc.rights This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
  • dc.subject.other Cor -- Malalties -- Prevenció
  • dc.subject.other Persones grans -- Malalties -- Prevenció
  • dc.subject.other Diabetis
  • dc.title Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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