April 12, 2006

Benefits of statins diminish after age 80

NEW YORK -- Although statins lower mortality in heart attack sufferers who are between 65 and 80 years old, they may not be as effective in older patients, according to a study.

"While statins reduce mortality in a wide range of older patients up to age 80 years, due to competing risks and decreased life expectancy, these agents have diminished benefits in those over the age of 80 years," Dr. JoAnne Micale Foody from Yale University School of Medicine in New Haven, Connecticut, told Reuters Health.

Foody and colleagues used Medicare claims data to investigate the effect of statins on outcomes in more than 65,000 patients with a hospital discharge diagnosis of acute myocardial infarction (heart attack).

Less than a quarter of them who were eligible for statin initiation after the event were actually taking a statin upon hospital discharge, the authors report. Overall, 3-year mortality was 11 percent lower for patients receiving statins.

However, statin therapy was associated with a significant 16 percent reduction in all-cause mortality in patients younger than 80 years. This was not the case in patients aged 80 years and older.

"Bad" LDL cholesterol level also interacted with statin therapy to influence survival, the researchers note. Patients who had high levels of LDL cholesterol (above 130 mg/dL) were most likely to benefit from statin therapy, and patients who had LDL cholesterol levels below 100 mg/dL were least likely to benefit.

"Decision-making in older persons is often complex and requires the careful balancing of potential benefits, risks of therapies, as well as accounting for patient preferences for clinical outcomes," Foody said.

"Many of the interventions we apply in patients of this age group have few clinical data to support their use, but in well-selected individual patients, we are likely to see benefits."

"Randomized clinical trials," she and colleagues conclude, "will be required to address the potential role of statins in the significant and growing proportion of patients aged 80 and older who remain at risk for cardiovascular events."

SOURCE: Journal of the American Geriatrics Society, March 2006.