Are Statins Beneficial for Primary Prevention in Older Adults?

For patients over 65 years old with hypertension and moderate hyperlipidemia, statin use for primary prevention was not associated with significant improvements in all-cause mortality or cardiovascular outcomes compared to usual care. Findings from this study were published online in JAMA Internal Medicine.

The researchers based their analysis on the Lipid-Lowering Trial (LLT) component of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). A total of 1,467 were randomized to receive pravastatin while 1,400 received usual care (UC). Mean low-density lipoprotein cholesterol levels at baseline were similar for both groups; 147.7 (19.8) mg/dL in the pravastatin group and 147.6 (19.4) mg/dL in the UC group.

Results showed no significant differences in coronary heart disease (CHD) between the groups. At year 6, the mean low-density lipoprotein cholesterol levels were 109.1 (35.4) mg/dL and 128.8 (27.5) mg/dL, for the pravastatin and UC group, respectively. For all adults ≥65 years, all-cause mortality hazard ratios in the pravastatin group compared to the UC group were 1.18 ( (95% CI, 0.97–1.42; P=0.09); 1.08 (95% CI, 0.85–1.37; P=0.55) for adults aged 65 to 74 years, and 1.34 (95% CI, 0.98–1.84; P=0.07) for those ≥75 years. Additionally, no significant difference was found in the multivariable regression analysis. 

The authors concluded that newly administered statins given for primary prevention provided no benefit to these patients with regards to all-cause mortality or CHD events. They noted, “A nonsignificant direction toward increased all-cause mortality with the use of pravastatin in the age group 75 years and older, but there was no significant interaction between treatment group and age.”

For more information visit JAMAnetwork.com.