Statins reduced the risk of coronary artery disease (RR 0.79; 95% CI 0.68-0.91) in primary prevention and all-cause mortality (RR 0.80; 95% CI 0.73-0.89) in secondary prevention for older adults.
Meta-Analysis (n=60,194)
Do lipid-lowering agents reduce cardiovascular events and mortality in individuals aged 65 years or older?
Statins provide significant secondary prevention benefits, including reduced all-cause mortality, in individuals aged 65 years or older.
Effect estimate: RR 0.79 (95% CI 0.68 to 0.91)
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.
Ponce et al. (Sat,) conducted a meta-analysis in Primary and secondary prevention of cardiovascular disease (n=60,194). Lipid-lowering agents (statins, niacin, fibrates) was evaluated on Coronary artery disease (primary prevention) (RR 0.79, 95% CI 0.68 to 0.91). Statins reduced the risk of coronary artery disease (RR 0.79; 95% CI 0.68-0.91) in primary prevention and all-cause mortality (RR 0.80; 95% CI 0.73-0.89) in secondary prevention for older adults.
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