Statin Therapy for Primary Prevention in the Elderly and Its Association with New-Onset Diabetes, Cardiovascular Events, and All-Cause Mortality

PURPOSE: This study assessed associations of the use of statins for primary prevention with cardiovascular outcomes among adults ages >70 years. METHODS: In a retrospective population-based cohort study, new users of statins without cardiovascular disease or diabetes mellitus were stratified by ages >70 years and <70 years. Using a time-dependent approach, adherence to statins was evaluated according to the proportion of days covered: <25%, 25%50%, 50%-75%, and >75%. We assessed associations of statin therapy with increased risk of new-onset diabetes mellitus and with decreased risks of major adverse cardiovascular events and all-cause mortality. RESULTS: Of 42,767 new users of statins, 5970 (14%) were ages >70 years. The incident rates of major adverse cardiovascular events, all-cause mortality, and new-onset diabetes mellitus in the highest to lowest proportion of days covered categories were 16.9%, 16.7%, and 9.4% and 6.3%, 1.7%, and 9.4%, respectively. For the older group, the adjusted hazard ratios of major adverse cardiovascular events and mortality were significantly decreased for the highest adherence group (proportion of days covered >75%): 0.71 (0.57-0.88) and 0.68 (0.54-0.84), respectively. The respective hazard ratios were less favorable for the younger group: 0.80 (0.68-0.93) and 0.74 (0.58-1.03). The risk of new-onset diabetes mellitus was increased for the younger but not the older group. CONCLUSIONS: Statin use for primary prevention was associated with cardiovascular benefit in adults ages >70 years without a significant risk for the development of diabetes. These data may support the use of statin therapy for primary prevention in the elderly. (C) 2020 Elsevier Inc. All rights reserved.

Automated summary

This study found that the use of statins for primary prevention of cardiovascular disease in adults over 70 years old is beneficial and does not increase the risk of diabetes. However, for individuals under 70 years old, the risk-benefit ratio of statin therapy is less favorable compared to the older group.