Department of Medicine, Clinical Pharmacology Unit, Karolinska Institute, Stockholm, Sweden.
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Eur J Clin Pharmacol. 2019 Jul;75(7):959-967. doi: 10.1007/s00228-019-02645-w. Epub 2019 Mar 3.
To investigate statin use in the elderly by age (≥ 80 vs. 65-79 years) in relation to established indications.
A population-based cohort, including data from four registers, encompassing inhabitants in Region Västra Götaland, Sweden, was used. Statin users were defined as those filling statin prescriptions ≥ 75% of the year 2010. Primary care and hospital diagnoses in 2005-2010 regarding ischemic heart disease, stroke, transient ischemic attacks, and diabetes were considered established indications.
A total of 278,205 individuals were analyzed. In individuals aged ≥ 80 and 65-79 years (n = 81,885 and n = 196,320, respectively), 17% (95% confidence interval 17%; 18%) and 23% (23%; 23%) respectively, were statin users. Among the statin users, 74% (73%; 74%) of those aged ≥ 80 and 60% (59%; 60%) of those aged 65-79 years had ≥ 1 established indication. Conversely, of those with ≥ 1 established indication, 30% (30%; 31%) and 53% (52%; 53%) were on statins in the respective age groups. Logistic regression revealed that age, nursing home residence, and multi-dose drug dispensing were the most prominent negative predictors for statin use; adjusted odds ratios (95% confidence interval): 0.45 (0.44; 0.46), 0.39 (0.36; 0.42), and 0.47 (0.44; 0.49), respectively.
In the oldest old (≥ 80 years), statin users were fewer and had more often an established indication, suggesting that physicians extrapolate scientific evidence for beneficial effects in younger age groups to the oldest, but require a more solid ground for treatment. As the oldest old, nursing home residents, and those with multi-dose drug-dispensing were statin users to a lesser extent, physicians may often refrain from treatment in those with lower life expectancy, either due to age or to severely reduced health status. In both age groups, our results however also indicate some over- as well as undertreatment.
通过年龄（≥80 岁与 65-79 岁）比较，研究老年人中他汀类药物的使用情况与既定适应证的关系。
本研究使用了一项基于人群的队列研究，数据来自四个登记处，涵盖了瑞典西约塔兰地区的居民。他汀类药物使用者被定义为在 2010 年全年至少有 75%的时间内开具了他汀类药物处方。2005-2010 年期间，将初级保健和医院的缺血性心脏病、中风、短暂性脑缺血发作和糖尿病诊断作为既定适应证。
共分析了 278205 人。在≥80 岁和 65-79 岁的个体中（n=81885 和 n=196320），分别有 17%（95%置信区间 17%；18%）和 23%（23%；23%）的人使用了他汀类药物。在他汀类药物使用者中，≥80 岁的患者中有 74%（73%；74%）和 65-79 岁的患者中有 60%（59%；60%）至少有一个既定适应证。相反，在有≥1个既定适应证的患者中，分别有 30%（30%；31%）和 53%（52%；53%）在各自的年龄组中使用了他汀类药物。Logistic 回归显示，年龄、疗养院居住和多剂量药物配给是他汀类药物使用的最显著负预测因素；调整后的优势比（95%置信区间）分别为：0.45（0.44；0.46）、0.39（0.36；0.42）和 0.47（0.44；0.49）。
在最年长的老年人（≥80 岁）中，他汀类药物使用者较少，且更常具有既定适应证，这表明医生将年轻人群中有益效果的科学证据外推到最年长的人群，但需要更坚实的治疗基础。由于最年长的老年人、疗养院居民和多剂量药物配给的患者使用他汀类药物的程度较低，医生可能由于年龄或健康状况严重下降而避免对预期寿命较低的患者进行治疗。然而，在这两个年龄组中，我们的结果也表明存在一定程度的过度和不足治疗。
