Statins for secondary prevention of coronary artery disease in patients aged 80 years or older: a nation-wide propensity score-based analysis

Abstract Patients with established coronary artery disease are recommended statin therapy for secondary prevention, but randomised trials rarely include individuals above 80 years of age. Therefore, we sought to assess the impact of statin therapy on all-cause mortality and cardiovascular hospitalisations in a nation-wide cohort of patients hospitalised for coronary artery disease aged 80 years or older. Patients hospitalised for coronary artery disease (acute and chronic coronary syndromes; ICD diagnoses I20.x, I21.x, and I25.x) were retrospectively identified by linking the national hospital database, medicines reimbursement claims, and the national mortality registry, using unique patient identifiers. Patient aged 80 years or more were included, with follow-up time of 5 years. The impact of statin prescription at discharge on clinical outcomes (all-cause mortality and/or cardiovascular hospitalisations) was assessed by Kaplan-Meier curves and Cox proportional hazards regression model with inverse probability of treatment weights, calculated using covariate-balancing propensity scores. A landmark period of 30 days post-discharge was used to address survival bias. We included 5 ,618 patients with coronary artery disease aged 80 years or more; 2,973 were prescribed a statin within 30 days from discharge. Median age was 83 years (IQR 81–86 years), 49% were men, 42% had chronic coronary syndromes, 25% had heart failure, 27% had atrial fibrillation, 22% had diabetes mellitus, 63% had arterial hypertension, 6.7% had depression. After inverse probability of treatment weighting, uptake of statin therapy was associated with a 11.2% reduction in all-cause mortality and cardiovascular hospitalisations (HR 0.89, 95%CI 0.82-0.97, p0.001). See Figure 1. In conclusion, statin therapy in patients with coronary artery disease aged 80 years or older is associated with a moderate reduction in all-cause mortality and cardiovascular rehospitalisations.