June 13, 2016
View Full PaperEffect of Statin Therapy on Mortality in Older Adults Hospitalized with Coronary Artery Disease: A Propensity‐Adjusted Analysis
Key Result
Statin therapy at discharge was not significantly associated with lower long-term all-cause mortality in older adults hospitalized with CAD after propensity adjustment (HR 0.88; 95% CI 0.74-1.05).
Study Design
Type
Cohort (n=1,262)
Multicenter
No
Structured PICO
Does statin therapy reduce all-cause mortality in older adults (aged ≥80) hospitalized with coronary artery disease?
P
Population
1,262 adults aged 80 and older hospitalized with coronary artery disease and discharged alive, followed for a median of 3.1 years.
E
Exposure
Discharge prescription for a statin
C
Comparator
No discharge prescription for a statin
O
Outcome
All-cause mortality over a median follow-up of 3.1 yearshard clinical
In adults aged 80 and older hospitalized with CAD, statin therapy at discharge was not associated with a significant reduction in long-term mortality after propensity adjustment, calling into question its secondary prevention benefit in this age group.
Main Result
Hazard Ratio: 0.88 (95% CI 0.74–1.05)
Abstract
OBJECTIVES: To examine the effect of statins on long-term mortality in older adults hospitalized with coronary artery disease (CAD). DESIGN: Retrospective analysis. SETTING: University teaching hospital. PARTICIPANTS: Individuals aged 80 and older (mean aged 85.2, 56% female) hospitalized from January 2006 to December 2010 with acute myocardial infarction (AMI), unstable angina pectoris, or chronic CAD and discharged alive (N = 1,262). Participants were divided into those who did (n = 913) and did not (n = 349) receive a discharge prescription for a statin. MEASUREMENTS: All-cause mortality over a median follow-up of 3.1 years. RESULTS: Participants treated with statins were more likely to be male, to have a primary diagnosis of AMI, to have traditional cardiovascular risk factors, and to receive other standard cardiovascular medications in addition to statins. In unadjusted analysis, statin therapy was associated with lower mortality (hazard ratio (HR) = 0.83, 95% confidence interval (CI) = 0.71-0.96). After adjustment for baseline differences between groups and propensity for receiving statin therapy, the effect of statins on mortality was no longer significant (HR = 0.88, 95% CI = 0.74-1.05). The association between statins and mortality was similar in participants aged 80 to 84 and those aged 85 and older. CONCLUSION: In this cohort of older adults hospitalized with CAD, statin therapy had no significant effect on long-term survival after adjustment for between-group differences. These findings, although preliminary, call into question the benefit of statin therapy for secondary prevention in a real-world population of adults aged 80 and older and underscore the need for shared decision-making when prescribing statins in this age group.