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Comparison of statins for primary prevention of cardiovascular disease and persistent physical disability in older adults.
Eur J Clin Pharmacol. 2022 Mar; 78(3):467-476.EJ

Abstract

PURPOSE

Recent epidemiological evidence has suggested that use of lipid-lowering medications, particularly statins, was associated with reduced cardiovascular disease (CVD) events and persistent physical disability in healthy older adults. However, the comparative efficacy of different statins in this group remains unclear. This study aimed to compare different forms of statins in their associations with CVD and physical disability in healthy older adults.

METHODS

This post hoc analysis included data from 5981 participants aged ≥ 70 years (≥ 65 if US minorities; median age:74.0) followed for a median of 4.7 years, who had no prior CVD events or physical disability and reported using a statin at baseline. The incidence of the composite and components of major adverse cardiovascular events and persistent physical disability were compared across different statins according to their type, potency, and lipophilicity using multivariable Cox proportional-hazards models.

RESULTS

Atorvastatin was the most used statin type at baseline (37.9%), followed by simvastatin (29.6%), rosuvastatin (25.5%), and other statins (7.0%, predominantly pravastatin). In comparisons of specific statins according to type and lipophilicity (lipophilic vs. hydrophilic statin), observed differences in all outcomes were small and not statistically significant (all p values > 0.05). High-potency statin use (atorvastatin and rosuvastatin) was marginally associated with lower risk of fatal CVD events compared with low-/moderate-potency statin use (hazard ratio: 0.59; 95% confidence interval: 0.35, 1.00).

CONCLUSION

There were minimal differences in CVD outcomes and no significant difference in persistent physical disability between various forms of statins in healthy older adults. Future investigations are needed to confirm our results.

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Authors+Show Affiliations

Zhou Z
Menzies Institute for Medical Research, University of Tasmania, TAS, 17 Liverpool Street, Hobart, 7000, Australia. zhen.zhou@utas.edu.au.
Curtis AJ
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Ernst ME
Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA. Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, IA, USA.
Ryan J
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Zoungas S
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Wolfe R
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
McNeil JJ
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Murray AM
Berman Center for Outcomes and Clinical Research, Division of Geriatrics, Department of Medicine Hennepin HealthCare, Hennepin Healthcare Research Institute, University of Minnesota, Minneapolis, MN, USA.
Reid CM
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. School of Public Health, Curtin University, Perth, WA, Australia.
Chowdhury EK
School of Public Health, Curtin University, Perth, WA, Australia.
Woods RL
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Tonkin AM
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Nelson MR
Menzies Institute for Medical Research, University of Tasmania, TAS, 17 Liverpool Street, Hobart, 7000, Australia.

MeSH

AgedAged, 80 and overAtorvastatinCardiovascular DiseasesDisabled PersonsDouble-Blind MethodFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMalePravastatinPrimary PreventionProportional Hazards ModelsRosuvastatin CalciumSimvastatin

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

34698889

Citation

Zhou, Zhen, et al. "Comparison of Statins for Primary Prevention of Cardiovascular Disease and Persistent Physical Disability in Older Adults." European Journal of Clinical Pharmacology, vol. 78, no. 3, 2022, pp. 467-476.
Zhou Z, Curtis AJ, Ernst ME, et al. Comparison of statins for primary prevention of cardiovascular disease and persistent physical disability in older adults. Eur J Clin Pharmacol. 2022;78(3):467-476.
Zhou, Z., Curtis, A. J., Ernst, M. E., Ryan, J., Zoungas, S., Wolfe, R., McNeil, J. J., Murray, A. M., Reid, C. M., Chowdhury, E. K., Woods, R. L., Tonkin, A. M., & Nelson, M. R. (2022). Comparison of statins for primary prevention of cardiovascular disease and persistent physical disability in older adults. European Journal of Clinical Pharmacology, 78(3), 467-476. https://doi.org/10.1007/s00228-021-03239-1
Zhou Z, et al. Comparison of Statins for Primary Prevention of Cardiovascular Disease and Persistent Physical Disability in Older Adults. Eur J Clin Pharmacol. 2022;78(3):467-476. PubMed PMID: 34698889.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of statins for primary prevention of cardiovascular disease and persistent physical disability in older adults. AU - Zhou,Zhen, AU - Curtis,Andrea J, AU - Ernst,Michael E, AU - Ryan,Joanne, AU - Zoungas,Sophia, AU - Wolfe,Rory, AU - McNeil,John J, AU - Murray,Anne M, AU - Reid,Christopher M, AU - Chowdhury,Enayet K, AU - Woods,Robyn L, AU - Tonkin,Andrew M, AU - Nelson,Mark R, Y1 - 2021/10/26/ PY - 2021/01/24/received PY - 2021/10/19/accepted PY - 2021/10/27/pubmed PY - 2022/3/1/medline PY - 2021/10/26/entrez KW - Cardiovascular disease KW - Primary prevention KW - Statins KW - Survival KW - The aged SP - 467 EP - 476 JF - European journal of clinical pharmacology JO - Eur J Clin Pharmacol VL - 78 IS - 3 N2 - PURPOSE: Recent epidemiological evidence has suggested that use of lipid-lowering medications, particularly statins, was associated with reduced cardiovascular disease (CVD) events and persistent physical disability in healthy older adults. However, the comparative efficacy of different statins in this group remains unclear. This study aimed to compare different forms of statins in their associations with CVD and physical disability in healthy older adults. METHODS: This post hoc analysis included data from 5981 participants aged ≥ 70 years (≥ 65 if US minorities; median age:74.0) followed for a median of 4.7 years, who had no prior CVD events or physical disability and reported using a statin at baseline. The incidence of the composite and components of major adverse cardiovascular events and persistent physical disability were compared across different statins according to their type, potency, and lipophilicity using multivariable Cox proportional-hazards models. RESULTS: Atorvastatin was the most used statin type at baseline (37.9%), followed by simvastatin (29.6%), rosuvastatin (25.5%), and other statins (7.0%, predominantly pravastatin). In comparisons of specific statins according to type and lipophilicity (lipophilic vs. hydrophilic statin), observed differences in all outcomes were small and not statistically significant (all p values > 0.05). High-potency statin use (atorvastatin and rosuvastatin) was marginally associated with lower risk of fatal CVD events compared with low-/moderate-potency statin use (hazard ratio: 0.59; 95% confidence interval: 0.35, 1.00). CONCLUSION: There were minimal differences in CVD outcomes and no significant difference in persistent physical disability between various forms of statins in healthy older adults. Future investigations are needed to confirm our results. SN - 1432-1041 UR - https://www.unboundmedicine.com/medline/citation/34698889/Comparison_of_statins_for_primary_prevention_of_cardiovascular_disease_and_persistent_physical_disability_in_older_adults_ DB - PRIME DP - Unbound Medicine ER -