Effectiveness of statins for the primary prevention of cardiovascular disease in the Asian elderly population

Abstract

BackgroundPopulation aging is a global trend, and the elderly have a higher risk of atherosclerotic cardiovascular disease (ASCVD) and related mortality. Statins have been observed to reduce cardiovascular events in patients with ASCVD. However, compared with secondary prevention, the benefits of statins for primary prevention are undetermined among the elderly. AimsThis study aimed to evaluate the effectiveness of statins in an elderly population without a history of cardiovascular disease (CVD). MethodsThe study was carried out using the National Taiwan University Hospital Integrated Medical Database and the National Health Insurance Research Database in Taiwan. Patients aged 65 years and older without a history of CVD were identified between 1 February 2008 and 31 December 2015. New statin users were 1:4 matched to nonusers based on certain variables. The risks of major adverse cardiovascular events (MACEs) and all-cause mortality were estimated using Cox proportional hazards models. Further, we applied marginal structural models to account for time-varying low-density lipoprotein cholesterol (LDL-C) levels. ResultsA total of 2761 new statin users and 9503 nonusers were selected after matching; the mean age was 71.8 years, and 63% were women. At a median follow-up of 4.8 years, statin use was associated with reduced risk of MACEs (hazard ratio [HR]: 0.75; 95% confidence interval [CI], 0.52–0.98) and mortality (HR: 0.72, 95% CI: 0.55–0.93) when accounting for time-varying LDL-C. No significant differences in effect were detected between subgroups. ConclusionStatin use could be beneficial for the primary prevention of CVD in elderly Asians.