Journal
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
Volume 54, Issue 3, Pages 421-430Publisher
WILEY
DOI: 10.1111/j.1532-5415.2005.00635.x
Keywords
lipids; myocardial infarction; elderly; treatment
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Funding
- NIA NIH HHS [K08-AG01011, K08 AG020623, K08-AG20623-01, K08 AG001011] Funding Source: Medline
- NIGMS NIH HHS [T32 GM007205, GM07205, T32 GM007205-35] Funding Source: Medline
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OBJECTIVES: To characterize the relationship between hydroxymethylglutaryl-CoA reductase inhibitors (statins) and outcomes in older persons with acute myocardial infarction (AMI). DESIGN: Observational study. SETTING: Acute care hospitals in the United States from April 1998 to June 2001. PARTICIPANTS: Medicare patients aged 65 and older with a principal discharge diagnosis of AMI (N = 65,020) who did and did not receive a discharge prescription for statins. MEASUREMENTS: The primary outcome of interest was all-cause mortality at 3 years after discharge. RESULTS: Of 23,013 patients with AMI assessed, 5,513 (24.0%) were receiving a statin at discharge. Nearly 40% of eligible patients (n=8,452) were aged 80 and older, of whom 1,310 (15.5%) were receiving a statin at discharge. In a multivariable model taking into account demographic, clinical, physician and hospital characteristics, and propensity score, discharge statin therapy was associated with significantly lower 3-year mortality (hazard ratio (HR) = 0.89 (95% confidence interval (CI) = 0.83-0.96)). In an analysis stratified by age, discharge statins were associated with lower mortality in patients younger than 80 (HR = 0.84, 95% CI = 0.76-0.92) but not in those aged 80 and older (HR= 0.97, 95% CI = 0.87-1.09). CONCLUSION: Statin therapy is associated with lower mortality in older patients with AMI younger than 80 but not in those aged 80 and older, as a group. This finding questions whether statin efficacy data in younger patients can be broadly applied to the very old and indicates the need for further study of this group.
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