期刊
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
卷 65, 期 11, 页码 2362-2368出版社
WILEY
DOI: 10.1111/jgs.14993
关键词
prevention; cardiovascular disease; statins; aging
资金
- National Cancer Institute [CA-30 34944, CA-40360, CA-097193]
- NHLBI [HL-26490, HL-34595]
- AFAR: the John A. Hartford Foundation Centers of Excellence in Geriatrics Program
- Veterans Administration Merit Award [1I01CX000934-01A1]
BACKGROUND/OBJECTIVES: We sought to determine whether statin use for primary prevention is associated with a lower risk of cardiovascular events or mortality in older men. DESIGN: Prospective cohort study. SETTING: Physicians' Health Study participants. PARTICIPANTS: 7,213 male physicians >= 70 years without a history of cardiovascular disease (CVD). MEASUREMENTS: Multivariable propensity score for statin use with greedy matching (1: 1) to minimize confounding by indication. RESULTS: Median baseline age was 77 (70-102), median follow-up was 7 years. Non-users were matched to 1,130 statin users. Statin use was associated with an 18% lower risk of all-cause mortality, HR 0.82 (95% CI 0.69-0.98) and non-significant lower risk of CVD events, HR 0.86 (95% CI 0.70-1.06) and stroke, HR 0.70 (95% CI 0.45-1.09). In subgroup analyses, results did not change according to age group at baseline (70-76 or >76 years) or functional status. There was a suggestion that those >76 at baseline did not benefit from statins for mortality, HR 1.14 (95% CI 0.89-1.47), compared to those 70-76 at baseline, HR 0.83 (95% CI 0.61-1.11); however the CIs overlap between the two groups, suggesting no difference. Statin users with elevated total cholesterol had fewer major CVD events than non-users, HR 0.68 (95% CI 0.50-0.94) and HR 1.43 (95% CI 0.99-2.07)), respectively. CONCLUSIONS: Statin use was associated with a significant lower risk of mortality in older male physicians >= 70 and a nonsignificant lower risk of CVD events. Results did not change in those who were >76 years at baseline or according to functional status. There was a suggestion that those with elevated total cholesterol may benefit. Further work is needed to determine which older individuals will benefit from statins as primary prevention.
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