April 14, 2020
By Julie Gould
The results of a recent study published online in the Journal of the American Geriatrics Society, show that statin use should be initiated after myocardial infarction (MI) in patients aged 80 years and older if continued for at least 2 years.
For the study, a team of researchers observed 9020 patients, 65 years and older, hospitalized after a first MI without a statin prescription in the year before hospitalization.
“Among the 3900 patients aged 80 years and older, 2 years of statin prescriptions resulted in a lower risk of the composite outcome (adjusted HR = 0.81; 95% confidence interval [CI] = 0.66‐0.99) and of all‐cause mortality (adjusted HR = 0.84; 95% CI = 0.73‐0.97),” the researchers found.
To better understand the study and its findings, we spoke with lead study author Geert Lefeber, MD, geriatrician and clinical pharmacologist, who has a special interest in cardiovascular disease.
What existing data led you and your co-investigators to conduct this research?
We performed our research using the Clinical Practice Research Datalink (CPRD), a real-word research service supporting retrospective public health and clinical studies. CPRD collects de-identified patient data from a network of GP practices across he UK. The data encompass 45 million patients, including 13 million currently registered patients.
More information is available from: https://www.cprd.com/
Please briefly describe your study and its findings. Were any of the outcomes particularly surprising?
A cohort study in the Clinical Practice Research Datalink was conducted between January 1, 1999 and February 26, 2016. A total of 3900 patients aged 80 and above, hospitalized for first MI, surviving 30 days after discharge, without statin treatment one year before hospitalization, were included. Time varying Cox regression was used to estimate HRs and 95% confidence intervals (CI) of statin treatment on the primary outcome and mortality, adjusted for confounders including frailty. HRs were converted into numbers needed to treat (NNT) and adjusted for two-year mortality.
Results: Comparing over two years statin treatment to no/less than two years statin treatment on the primary outcome resulted in a HR of 0.81 (95%CI 0.66–0.99) and a NNT of 59 over three years, increasing to 93 after adjusting for 36.2% mortality. Over two years, statin treatment decreased mortality (HR 0.84; 95%CI 0.73–0.97).
Conclusion: Protective effects of statins initiated after a first MI and continued for at least 2 years were found in patients aged 80 and older. When considering the mortality during and after hospitalization and competing risks thereafter in old age, initiating statins may not benefit all.
What surprised us most was that between one and two years of statin therapy compared to no treatment showed no effect in the patients aged 80 years and older on the primary outcome with an adjusted HR 1.01 (95%CI 0.77–1.34).
What are the possible real-world applications of these findings in clinical practice?
Our results confirm that patients need to take statins for minimally two years after a first MI to achieve benefit, regardless of a patient’s age. If patients aged 80 and older are at high risk of dying within two years of a first MI, it is not beneficial to initiate statin therapy. If initiation of statin treatment is considered beneficial in contributing to patient-centered goals, it is important to ensure that the patient remains adherent because short-term treatment was not found to be beneficial.
Do you and your co-investigators intend to expand upon this research?
We are currently working on an article on statin therapy initiated after stroke. Furthermore, we want to focus on more patient centered outcomes from a patient’s perspective.
Lefeber GJ, Koek HL, Souverein PC, Bouvy ML, de Boer A, Knol W. Statins After Myocardial Infarction in the Oldest: A Cohort Study in the Clinical Practice Research Datalink Database. J Am Geriatr Soc. 2020;68(2):329–336. doi:10.1111/jgs.16227