Benefits of statins in elderly subjects without established cardiovascular disease. a meta-analysis

Abstract

Background: Since ageing of the population is steadily raising, prevention of Cardiovascular (CV) disease in the elderly is relevant. In elderly patients with previous CV events, use of statins is recommended by guidelines, whereas the employ of these drugs in elderly subjects without previous CV events is still debated. The aim of the present study was to verify whether statins reduce all-cause mortality and CV events in elderly people without previous established CV disease. Methods: MEDLINE, Cochrane, ISI Web of Science and SCOPUS databases were searched for articles about statin treatment in patients without CV disease until December 2012. Study inclusion criteria were: randomized allocation to statin or placebo; age at randomization >65 years or report of outcomes in the subgroup of patients with age >65 years; report of at least 1 clinical event among all-cause death, CV death, Myocardial Infarction (MI), coronary revascularization, stroke and new cancer onset; report of outcomes separately for patients without established CV disease. Meta-analysis was performed to assess the influence of treatments on outcomes. Meta-regression analysis was performed to test the influence of potential effect modifiers on our results. Publication bias was assessed by a modified Macaskill's test. Results: Seven randomized trials comparing statins versus placebo in 23,258 subjects without CV disease were included in a meta-analysis. Statins compared to placebo reduced the risk of MI by 39.5% (relative risk [RR]: 0.605 [95% confidence interval (CI): 0.459 to 0.797]; p=0.000), coronary revascularization by 50.3% (RR: 0.497 [95% CI: 0.326 to 0.758]; p=0.001) and stroke by 24.6% (RR: 0.754 [95% CI: 0.588 to 0.966]; p=0.026), whereas the risk of all-cause death (RR: 0.938 [95% CI: 0.851 to 1.034]; p=0.196, CV death (RR: 0.911 [95% CI: 0.681 to 1.219]; p=0.530) and new cancer onset (RR: 0.934 [95% CI: 0.776 to 1.126]; p=0.476) was not influenced by treatment. Conclusions: In elderly subjects at high CV risk without established CV disease statins substantially reduce the incidence CV morbidities, but do not significantly prolong survival.