Key result
Statin use shows no association with disability-free survival in healthy older adults.
Why the study?
There is clinical uncertainty regarding the benefits and harms of prescribing statins in healthy subjects aged 70 years and older.
Does baseline statin use improve disability-free survival or reduce cardiovascular disease in healthy community-dwelling adults ≥70 years of age?
Cohort (n=18,096)
Yes
Does baseline statin use improve disability-free survival or reduce cardiovascular disease in healthy community-dwelling adults ≥70 years of age?
Hazard Ratio: 0.92 (95% CI 0.83–1.03)
Absolute Event Rate: 20.8% vs 21.9%
p-value: p=0.17
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Comparing our study results with findings from the main ASPREE trial, which showed minimal cardiovascular benefits but high bleeding risk from aspirin, primary prevention with statins seems to be a more promising strategy for healthy aging.”
“They may not have been followed long enough to really see that impact on mortality.... Also, this is a relatively older population with a lot of competing risks... It may be that people are dying from other causes that we just can't expect statins to decrease.”
“I believe in the properly selected elderly patient, we're going to see a mortality benefit with statin therapy.”
In healthy community-dwelling older adults (≥70 years), baseline statin use was not associated with prolonged disability-free survival, but observational evidence suggests it may reduce the incidence of physical disability and cardiovascular events.
BACKGROUND There is clinical uncertainty regarding the benefits and harms of prescribing statins in healthy subjects ≥70 years of age. OBJECTIVES The aim of this study was to examine the association among statins, dementia-free and disability-free survival, and cardiovascular disease (CVD) among healthy older adults using data from the ASPREE (Aspirin in Reducing Events in the Elderly) trial. METHODS ASPREE was a randomized trial of 19,114 community-dwelling persons in Australia and the United States ≥65 years of age and free of documented CVD, dementia, and disability. Data were collected for those ≥70 years of age, and participants who took statins at baseline were compared with those who did not using Cox proportional hazards regression with inverse probability weighting. The primary outcome, referred to as “disability-free survival,” was a composite of all-cause mortality, dementia, or persistent physical disability. Other outcomes included the individual components of the composite outcome, major adverse cardiovascular events, fatal CVD, myocardial infarction, and stroke. RESULTS Of the 18,096 included participants (median age 74.2 years, 56.0% women), 5,629 took statins at baseline. Over a median follow-up period of 4.7 years, baseline statin use was not associated with disability-free survival or with the risk for all-cause mortality or dementia. However, it was associated with lower risks for physical disability and all cardiovascular outcomes. CONCLUSIONS Among healthy community-dwelling adults ≥70 years of age, statin use may be beneficial for preventing physical disability and CVD but not beneficial for prolonging disability-free survival or avoiding death or dementia. Future clinical trials are needed to confirm these findings.
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Zhou et al. (2020) conducted a cohort in Healthy older adults without cardiovascular disease (n=18,096). Statin use at baseline vs. No statin use at baseline was evaluated on Disability-free survival (a composite of all-cause mortality, dementia, or persistent physical disability) (HR 0.92, 95% CI 0.83 to 1.03, p=0.17). Baseline statin use in healthy adults ≥70 years was not significantly associated with disability-free survival (HR 0.92, 95% CI 0.83 to 1.03, p=0.17) over a median follow-up of 4.7 years.
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