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.”
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