Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China. (W.X., A.L.L.).
Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, and Department of Family Medicine, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China (C.L.K.L.).
Ann Intern Med. 2024 Jun;177(6):701-710. doi: 10.7326/M24-0004. Epub 2024 May 28.
There is little consensus on using statins for primary prevention of cardiovascular diseases (CVDs) and all-cause mortality in adults aged 75 years or older due to the underrepresentation of this population in randomized controlled trials.
To investigate the benefits and risks of using statins for primary prevention in old (aged 75 to 84 years) and very old (aged ≥85 years) adults.
Sequential target trial emulation comparing matched cohorts initiating versus not initiating statin therapy.
Territory-wide public electronic medical records in Hong Kong.
Persons aged 75 years or older who met indications for statin initiation from January 2008 to December 2015 were included. Participants with preexisting diagnosed CVDs at baseline, such as coronary heart disease (CHD), were excluded from the analysis. Among 69 981 eligible persons aged 75 to 84 years and 14 555 persons aged 85 years or older, 41 884 and 9457 had history of CHD equivalents (for example, diabetes) in the respective age groups.
Initiation of statin therapy.
Incidence of major CVDs (stroke, myocardial infarction, or heart failure), all-cause mortality, and major adverse events (myopathies and liver dysfunction).
Of 42 680 matched person-trials aged 75 to 84 years and 5390 matched person-trials aged 85 years or older (average follow-up, 5.3 years), 9676 and 1600 of them developed CVDs in each age group, respectively. Risk reduction for overall CVD incidence was found for initiating statin therapy in adults aged 75 to 84 years (5-year standardized risk reduction, 1.20% [95% CI, 0.57% to 1.82%] in the intention-to-treat [ITT] analysis; 5.00% [CI, 1.11% to 8.89%] in the per protocol [PP] analysis) and in those aged 85 years or older (ITT: 4.44% [CI, 1.40% to 7.48%]; PP: 12.50% [CI, 4.33% to 20.66%]). No significantly increased risks for myopathies and liver dysfunction were found in both age groups.
Unmeasured confounders, such as lifestyle factors of diet and physical activity, may exist.
Reduction for CVDs after statin therapy were seen in patients aged 75 years or older without increasing risks for severe adverse effects. Of note, the benefits and safety of statin therapy were consistently found in adults aged 85 years or older.
Health Bureau, the Government of Hong Kong Special Administrative Region, China, and National Natural Science Foundation of China.
由于随机对照试验中这一年龄段人群代表性不足，75 岁及以上成年人使用他汀类药物进行心血管疾病（CVD）一级预防和全因死亡率的共识较少。
研究在 75 至 84 岁的老年人和 85 岁及以上的老年人中使用他汀类药物进行一级预防的益处和风险。
通过序贯目标试验模拟比较开始和不开始他汀类药物治疗的匹配队列。
在香港全岛范围内的公共电子病历中。
2008 年 1 月至 2015 年 12 月符合他汀类药物起始指征的 75 岁及以上的患者被纳入研究。基线时已患有明确的 CVD 如冠心病（CHD）的患者被排除在分析之外。在 69981 名 75 至 84 岁和 14555 名 85 岁及以上的合格人群中，各年龄组分别有 41884 名和 9457 名有 CHD 等效病史（如糖尿病）。
开始他汀类药物治疗。
主要 CVD 事件（中风、心肌梗死或心力衰竭）、全因死亡率和主要不良事件（肌病和肝功能障碍）。
在 42680 名匹配的 75 至 84 岁的个体试验和 5390 名匹配的 85 岁及以上的个体试验中（平均随访时间为 5.3 年），在每个年龄组中，分别有 9676 人和 1600 人发生了 CVD。在 75 至 84 岁的成年人中（意向治疗[ITT]分析中 5 年标准化风险降低 1.20%[95%CI，0.57%至 1.82%]；PP 分析中 5.00%[CI，1.11%至 8.89%]）和 85 岁及以上的成年人（ITT：4.44%[CI，1.40%至 7.48%]；PP：12.50%[CI，4.33%至 20.66%]）中，启动他汀类药物治疗可显著降低整体 CVD 发病率。在两个年龄组中均未发现肌病和肝功能障碍风险显著增加。
可能存在未测量的混杂因素，如饮食和体育活动等生活方式因素。
他汀类药物治疗后 CVD 减少，且未增加严重不良事件的风险。值得注意的是，他汀类药物治疗在 85 岁及以上的成年人中始终显示出获益和安全性。
中国香港特别行政区政府卫生署和国家自然科学基金。
