Abstract 10062: Statin Utilization in a Real-World Primary Prevention Cohort of Older Adults

Abstract

Introduction: Statins are a cost-effective therapy for prevention of atherosclerotic cardiovascular disease (ASCVD). Although the ACC/AHA guidelines recommend statins for primary prevention among various groups aged 40-75, the guidelines are less clear for older adults (>75y). We investigated statin use in older adults without ASCVD events, stratified by risk category, in a large healthcare network. Methods: Inclusion criteria were adults aged 75-79, without CAD, PVD or ischemic stroke. Statin utilization, based on the ACC/AHA 10-year ASCVD risk calculation, was evaluated in intermediate (7.5%-19.9%) and high-risk patients (≥ 20%). Patients were categorized into using low and ‘moderate or high’ intensity statins. Cox regression models were used to assess hazard ratios for ASCVD events and mortality over ≈6 years. Results: Among 8114 patients aged 75-79, 86.8% were high risk and 46% of these patients were on any statin. Compared with those on moderate or high intensity statins, older high-risk patients not on any statin had a significantly increased risk of MI [HR 1.53 (1.25-1.87); p<0.001] , stroke [HR 1.52 (1.17-1.96); p<0.01] and mortality [HR 1.43 (1.24-1.64); p<0.001] (Table 1). High risk older adults on no statin had a higher risk of MI compared to those high risk <75y on no statin [HR 1.15 (1.02-1.29); p value for age interaction <0.05]. Statin initiation probability for those without any statin at first healthcare interaction was ≈36% at 5 years. Conclusion: In a large healthcare network, 54% of high-risk primary prevention older adults were not on any statin and initiation remained low at 5 years. Lack of statin use was associated with increased ASCVD events and mortality in high-risk older adults. Given the benefits appreciated with statin use in this older population in contemporary practices, statin use may need to be more strongly considered for primary ASCVD prevention among high-risk older adults. Further studies are needed to assess the risk-benefit ratio.