Abstract 15173: Association of Specific Statins With Cardiovascular Disease, All-cause Mortality, and Disability-free Survival in Initially Healthy Older Adults

Abstract

Background: The effectiveness of specific statins for the primary prevention of cardiovascular disease (CVD) in older adults is not well-characterized. Objective: To assess whether specific statin subclasses according to type, potency and solubility are associated with lower risk of CVD, all-cause mortality and improved disability-free survival in older adults. Methods: The cohort included 18,090 subjects from a primary prevention trial of aspirin, aged ≥70 years, initially free of CVD, disability and dementia, and followed for a median of 4.7 years. Outcomes included major adverse cardiovascular event (MACE, definition see Table ), all-cause mortality and disability-free survival (a composite of persistent physical disability, all-cause mortality or dementia). Three multivariable Cox models were used to estimate hazard ratios (HRs) for each outcome comparing participants taking specific statin subclasses at baseline with baseline statin nonusers. Results: At baseline, participants’ median age was 74.2 years and 5,623 were using statins (31%). Atorvastatin (38%) was the most widely used, followed by simvastatin (30%), rosuvastatin (26%) and other statins (7%, mainly pravastatin). Compared with nonusers, the risk of MACE was significantly lower for atorvastatin (HR: 0.68, 95% CI: 0.48-0.96) and rosuvastatin users (0.59, 0.37-0.94), but not for simvastatin (0.82, 0.57-1.17) or other statin users (1.02, 0.54-1.93). A significant risk reduction in MACE was also seen for high-potency statin users and for both lipophilic and hydrophilic statin users but not for low/moderate-potency statin users. None of the specific statin subclasses was associated with improved disability-free survival or reduced all-cause mortality. ( Table ) Conclusions: In healthy older adults, specific statin subclasses were associated with varying cardiovascular benefits but none was associated with improved disability-free survival or reduced all-cause mortality.