Statin Use in Older Adults for Primary Cardiovascular Disease Prevention Across a Spectrum of Cardiovascular Risk

Abstract

Background: There remains uncertainty regarding optimal primary atherosclerotic cardiovascular disease (ASCVD) prevention practices for older adults. Objective: To assess statin treatment patterns and incident ASCVD among older patients for primary prevention across the spectrum of ASCVD risk. Design: Retrospective cohort study of participants without ASCVD aged 65–79 years. Patients were stratified by age (65–69, 70–75, > 75 years) and 10-year ASCVD risk category (low/borderline, intermediate, high) based on the Pooled Cohort Equations. Multivariable logistic regressions were used to identify predictors of moderate- or high-intensity statin prescriptions. Cox proportional models were used to estimate hazard ratios (HRs) for incident ASCVD. Participants: Patients aged 65–79 years without ASCVD from a Northern California health system. Main Measures: Statin prescriptions and incident ASCVD events. Key Results: There were 54,066 patients, with 10,288 (19%) aged > 75 years and 57% women. Compared with younger groups, adults > 75 years were less likely to be prescribed moderate- or high-intensity statin prescriptions across ASCVD risk groups (all p < 0.001); this persisted after multivariable adjustment including for ASCVD risk (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.74–0.86). Adults > 75 years were more likely to experience incident ASCVD (HR 1.42, 95% CI 1.23–1.63). Women (OR 0.85, 95% CI 0.81–0.89) and underweight older adults (OR 0.45, 95% CI 0.33–0.61) were also less likely to receive moderate- or high-intensity statins. Conclusions: Among older adults aged 65–79 years without prior ASCVD, those > 75 years of age were less likely to receive moderate- or high-intensity statins regardless of ASCVD risk compared with their younger counterparts, while experiencing more incident ASCVD. Efforts are warranted to study the reasons for age-based differences in statin use in older adults, particularly those at highest ASCVD risk.