In a study of veterans aged 65 years or older, new statin use lowered mortality and major adverse cardiovascular events (MACE) independent of frailty status, researchers report. “While evidence suggests older adults with limited life expectancy should not be prescribed a statin for primary prevention, this recommendation is only relevant to a small minority of older adults,” the authors conclude. “Those with frailty may have shortened estimated life expectancy compared to age-matched peers, but frailty itself is not a life-limiting condition. In fact, among frail older adults, most have a life expectancy within the 2-5 year timeframe needed to derive benefit from statins. Prevention of CVD events could significantly improve quality of life in this vulnerable population, though must be balanced with the potential for increased risk of adverse reactions and drug-drug interactions that are more common in those with frailty.”
The retrospective study included older adults without cardiovascular disease or prior statin use who were started on statins in 2002-2012. Frailty status was assessed with a 31-item index. Based on follow-up through 2017, the co-primary endpoint of all-cause mortality or MACE (myocardial infarction, stroke/transient ischemic attacks, revascularization, or cardiovascular death) showed the following: “We identified 710,313 Veterans (mean age (SD) 75.3(6.5), 98% male, 89% white); 86,327 (12.1%) were frail. Over mean follow-up of 8(5) years, there were 48.6 and 72.6 deaths per 1000 person-years (PY) among non-frail statin-users vs nonusers (weighted Incidence Rate Difference (wIRD)/1000 person years (PY), –24.0[95% CI, –24.5 to –23.6]), and 90.4 and 130.4 deaths per 1000 PY among frail statin-users vs nonusers (wIRD/1000 PY, –40.0[95% CI, –41.8 to –38.2]). There were 51.7 and 60.8 MACE per 1000PY among non-frail statin-users vs nonusers (wIRD/1000 PY, –9.1[95% CI, –9.7 to –8.5]), and 88.2 and 102.0 MACE per 1000 PY among frail statin-users vs nonusers (wIRD/1000 PY, –13.8[95% CI, –16.2 to –11.4]). There were no significant interactions by frailty for statin users vs non-users by either mortality or MACE outcomes, P interaction 0.770 and 0.319, respectively. Statin use was associated with lower risk of all-cause mortality (HR, 0.61 (0.60-0.61)) and MACE (HR 0.86 (0.85-0.87)).”