Statin use in older people primary prevention on cardiovascular disease: an updated systematic review and meta-analysis.

BACKGROUND

Evidence on statin use for primary prevention of cardiovascular disease (CVD) in older people needs to be extended and updated, aiming to provide further guidance for clinical practice.

METHODS

PubMed, EMBASE, Cochrane Library and Web of Science were searched for eligible observational studies comparing statin use vs. no-statin use for primary prevention of CVD in older people (age 65 years). The primary outcomes were all-cause mortality, CVD mortality, coronary heart disease (CHD)/myocardial infraction (MI), stroke and total CV events. Risk estimates of each relevant outcome were synthesized as a hazard ratio (HR) with 95% confidence interval (95% CI) using in the random-effects model.

RESULTS

Twelve eligible observational studies (n = 1,627,434) were enrolled. The pooled results suggested that statin use was associated with a significantly decreased risk of all-cause mortality (HR: 0.54, 95% CI: 0.46-0.63), CVD mortality (HR: 0.51, 95% CI: 0.39-0.65), CHD/MI (HR: 0.83, 95% CI: 0.69-1.00), stroke (HR: 0.79, 95% CI: 0.68-0.92) and total CV events (HR: 0.75, 95% CI: 0.66-0.85). The association in all-cause mortality still remained obvious at higher ages ( 70 years old, HR: 0.56, 95% CI: 0.44-0.71; 75 years old, HR: 0.70, 95% CI: 0.60-0.80; 85 years old, HR: 0.85, 95% CI: 0.74-0.97), 20% (HR: 0.47, 95% CI: 0.35-0.62) and 20% diabetic populations (HR: 0.50, 95% CI: 0.40-0.64), and 50% (HR: 0.68, 95% CI: 0.59-0.79) and 50% hypertensive populations (HR: 0.38, 95% CI: 0.16-0.88).

CONCLUSIONS

Statin use was related to a 46%, 49%, 17%, 21% and 25% risk reduction on all-cause mortality, CVD mortality, CHD/MI, stroke and total CV events in older patients, respectively. The significant association was also addressed in older patients and 75 years old individuals for CVD primary prevention.