Discharge statin therapy in older patients with AMI was associated with lower 3-year mortality overall (HR 0.89; 95% CI 0.83-0.96), but this benefit was limited to patients younger than 80.
Observational (n=65,020)
Yes
Does statin therapy at discharge reduce 3-year all-cause mortality in older patients (≥65 years) with acute myocardial infarction?
Statin therapy at discharge after AMI is associated with reduced 3-year mortality in older patients under 80, but this benefit is not observed in patients aged 80 and older.
Hazard Ratio: 0.89 (95% CI 0.83–0.96)
OBJECTIVES: To characterize the relationship between hydroxymethylglutaryl-CoA reductase inhibitors (statins) and outcomes in older persons with acute myocardial infarction (AMI). DESIGN: Observational study. SETTING: Acute care hospitals in the United States from April 1998 to June 2001. PARTICIPANTS: Medicare patients aged 65 and older with a principal discharge diagnosis of AMI (N=65,020) who did and did not receive a discharge prescription for statins. MEASUREMENTS: The primary outcome of interest was all-cause mortality at 3 years after discharge. RESULTS: Of 23,013 patients with AMI assessed, 5,513 (24.0%) were receiving a statin at discharge. Nearly 40% of eligible patients (n=8,452) were aged 80 and older, of whom 1,310 (15.5%) were receiving a statin at discharge. In a multivariable model taking into account demographic, clinical, physician and hospital characteristics, and propensity score, discharge statin therapy was associated with significantly lower 3-year mortality (hazard ratio (HR)=0.89 (95% confidence interval (CI)=0.83-0.96)). In an analysis stratified by age, discharge statins were associated with lower mortality in patients younger than 80 (HR=0.84, 95% CI=0.76-0.92) but not in those aged 80 and older (HR=0.97, 95% CI=0.87-1.09). CONCLUSION: Statin therapy is associated with lower mortality in older patients with AMI younger than 80 but not in those aged 80 and older, as a group. This finding questions whether statin efficacy data in younger patients can be broadly applied to the very old and indicates the need for further study of this group.
Foody et al. (2006) conducted an observational in acute myocardial infarction (n=65,020). Hydroxymethylglutaryl-CoA reductase inhibitors (statins) vs. No discharge prescription for statins was evaluated on all-cause mortality at 3 years after discharge (HR 0.89, 95% CI 0.83-0.96). Discharge statin therapy in older patients with AMI was associated with lower 3-year mortality overall (HR 0.89; 95% CI 0.83-0.96), but this benefit was limited to patients younger than 80.