Statin therapy is associated with reduced mortality across all age groups of individuals with significant coronary disease, including very elderly patients

OBJECTIVES This study evaluated the effect of statin therapy, on mortality, in individuals with significant coronary, artery, disease (CAD) stratified by age. BACKGROUND Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) significantly reduce morbidity and mortality in individuals with CAD. Unfortunately, the large statin trials excluded individuals over 80 years old, and it is therefore unknown whether very elderly individuals benefit from statins as do younger individuals. METHODS A cohort of 7,220 individuals with angiographically defined significant CAD (greater than or equal to70%) was included. Statin prescription was determined at hospital discharge. Patients were followed up for 3.3 +/- 1.8 years (maximum 6.8). Patients were grouped by age (<65, 65 to 79, and greater than or equal to80 years) to determine whether statin therapy reduced mortality in an age-dependent manner. RESULTS Average age was 65 +/- 12 years; 74% were male; and 31% had a postmyocardial infarction status. Overall mortality was 16%. Elderly patients were significantly less likely to receive statins than younger patients (greater than or equal to80 years: 19.8%; 65 to 79 years: 21.1%; <65 years: 28.0%; p <0.001). Mortality was decreased among statin recipients in all age groups: greater than or equal to80 years: 29.5% among patients not taking a statin versus 8.5% of those taking a statin (adjusted hazard ratio [HR] 0.50, p = 0.036); 65 to 79 years: 18.7% vs. 6.0% (HR 0.56, p < 0.001); and <65 years: 8.9% vs. 3.1% (HR 0.70, p = 0.097). CONCLUSIONS Statin therapy is associated with reduced mortality in all age groups of individuals with significant CAD, including very elderly individuals. Although older patients were less likely to receive statin therapy, they received a greater absolute risk reduction than younger individuals. More aggressive statin use after CAD diagnosis may, be indicated, even in older patients. (C) 2002 by the American College of Cardiology Foundation.