Statin use ‘remains suboptimal’ for primary prevention in elderly
MedWire News: Research shows that use of statins in the elderly is increasing, but that patterns of use are still suboptimal in those at high risk for cardiovascular disease (CVD).
The findings, published in the Journal of Clinical Lipidology, come from an analysis of combined data from the 2001 through 2006 National Health and Nutrition Examination Surveys (NHANES).
Jennifer Robinson and Benjamin Booth (University of Iowa, Iowa City, USA) evaluated lipid levels and the influence of age, gender, race or ethnicity, and disease status on patterns of statin use in the age groups, 65-69, 70-74, 75-79, and ≥80 years.
They show that the use of statins increased in all age, gender, and risk categories between the 2001-2002 and 2005-2006 surveys.
Overall, participants with diabetes, CVD, or both conditions were two, three, and five times more likely to use statins than those without either condition, respectively.
However, although statin use in those with diabetes, CVD, or both, was greater among those aged 75-79 years than those aged 65-69-years (range 54-68% of the population vs 20-64%, respectively), it was lowest in those aged ≥80 years (16-48%).
A previous study showed that the percentage of people meeting low-density lipoprotein (LDL) cholesterol targets, as defined by National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III guidelines, decreases with increasing age (63% of those aged 60-69 years vs 55% aged 70-79).
Robinson and Booth report that less than 27% of men aged 65-79 years, among whom statin therapy should (LDL cholesterol ≥130 mg/dl) or could (LDL cholesterol ≥100 mg/dl) be considered, according to the NCEP ATP III guidelines, were receiving statin therapy, and this proportion was similar in women.
They therefore suggest that statins are being underused in the primary prevention population of individuals: those without clinically evident CVD or diabetes.
Further analysis revealed significant interactions between gender and age with regard to statin usage; there was a trend toward less usage in participants aged ≥70 years relative to those aged 65-69 years and among women versus men, yet women aged 75-79 years were a significant two times more likely to use statins than men aged 65-69 years.
The researchers also note that non-White participants were generally less likely to receive statins than Whites.
The team concludes that increased statin usage by the elderly has undoubtedly contributed to declines in CVD morbidity and mortality over the past decade.
Nevertheless, they write: "Statin use remains suboptimal, and efforts to increase statin utilization for both the primary and secondary prevention of CVD in the elderly should continue. Efforts to address disparities in statin use with advancing age, in women, and non-Whites are also needed."
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By Nikki Withers