Physicians' Academy for Cardiovascular Education

No benefit statin use for primary prevention in the elderly

Effect of Statin Treatment vs Usual Care on Primary Cardiovascular Prevention Among Older Adults

The ALLHAT-LLT Randomized Clinical Trial

Literature - Han BH, Sutin D, Williamson JD et al. - JAMA intern med 2017; epub ahead of print

Main results

Conclusion

Newly administered statin use for primary prevention had no benefit on all-cause mortality of coronary heart disease events compared to usual care in adults older than 65 years with hypertension and moderate hypercholesterolemia in the ALLHAT-LLT trial. In contrast, a non-significant direction towards increased all-cause mortality was noted with the use of pravastatin in patients of 75yrs and older.

Editorial comment

In this editorial [8], Dr. Curfman mentions that the US preventative services task force last year concluded that there is insufficient evidence to conclude about the balance of benefits and harms of statin therapy for the primary prevention of cardiovascular events and mortality in adults older than 75 years. Nevertheless, they are commonly prescribed to these patients and the prevalence of use is increasing. He notes that there is limited data about statin use in the patient group from the PROSPER, JUPITER and HOPE-3 clinical trials, in which is concluded that there is modest benefit on composite cardiovascular outcomes but not on all-cause mortality. He further elaborates on the trend towards increased mortality when using pravastatin in the ALLHAT-LLT trial, in which side effects known for statins may play a role.

References

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Find this article online at JAMA intern med

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