Study Questions Use of Statins for Primary Cardiovascular Prevention in Older Adults

Pravastatin does not reduce the risk of all-cause or coronary heart disease-related mortality in adults over 65 years of age, according to the findings of a recent study.

The researchers conducted a post hoc secondary analysis of data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT) that included 2867 participants with hypertension but without atherosclerotic cardiovascular disease at baseline. Participants were randomly assigned to receive 40 mg of pravastatin a day (n=1467) or usual care (n=1400). All-cause mortality was the primary outcome, and cause-specific mortality and nonfatal myocardial infarction or fatal coronary heart disease events were the secondary outcomes.
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In the pravastatin group, the mean baseline low-density lipoprotein cholesterol level was 147.7 mg/dL, the mean age was 71.3 years, and 704 participants were female (48%). The mean baseline low-density lipoprotein cholesterol level for participants in the usual care group was 147.6 mg/dL, the mean age was 71.2 years, and 711 participants (50.8%) were female.

The mean low-density lipoprotein cholesterol level by year 6 was 109.1mg/dL in participants in the pravastatin group and 128.8 mg/dL in participants in the usual care group.

At year six, 42 out of 253 (16.6%) patients assigned to receive pravastatin were not taking any statins, while 71% of participants assigned to receive usual care were not taking any statins. The hazard ratio for all-cause mortality for participants in the pravastatin group verses participants who received usual care was 1.18 for adults 65 years of age and older, 1.08 for adults 65 to 74 years of age, and 1.34 for adults 75 years of age and older.

There were no significant differences in coronary heart disease event rates between the statin and non-statin groups, and the results remained nonsignificant in multivariable regression analysis.

“This secondary analysis of the subset of older adults who participated in the ALLHAT-LLT showed no benefit of primary prevention for all-cause mortality or CHD events when pravastatin was initiated for adults 65 years and older with moderate hyperlipidemia and hypertension,” the researchers concluded. “A nonsignificant trend toward increased all-cause mortality with pravastatin was observed among adults 75 years and older.”

—Melissa Weiss

Reference:

Han BH, Sutin D, Williamson JD, et al. Effect of statin treatment vs usual care on primary cardiovascular prevention among older adults: the ALLHAT-LLT randomized clinical trial [published online May 22, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.1442.