 |
|
Therapy With Hydroxymethylglutaryl Coenzyme A Reductase Inhibitors (Statins) and Associated Risk of Incident Cardiovascular Events in Older Adults
Evidence From the Cardiovascular Health Study
Rozenn N. Lemaitre, PhD, MPH;
Bruce M. Psaty, MD, PhD;
Susan R. Heckbert, MD, PhD;
Richard A. Kronmal, PhD;
Anne B. Newman, MD;
Gregory L. Burke, MD
Arch Intern Med. 2002;162:1395-1400.
Background Recommendations to treat older adults with hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) for the primary prevention of coronary heart disease events are supported by a single clinical trial restricted to adults 73 years or younger with low levels of high-density lipoprotein cholesterol.
Methods We investigated the association of statin use with incident cardiovascular disease and all-cause mortality during up to 7.3 years' follow-up of 1250 women and 664 men from the Cardiovascular Health Study. Study participants were 65 years and older and free of cardiovascular disease at baseline. They received drug therapy to lower cholesterol levels at baseline or no treatment with a recommendation for therapy according to the National Cholesterol Education Program guidelines. Use of these drugs was assessed annually. We used proportional-hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for confounding variables.
Results We found 382 incident cardiovascular events (159 myocardial infarctions, 159 strokes, and 64 deaths due to coronary heart disease) and 362 total deaths from June 1, 1989, to May 31, 1997. Compared with no use of drugs to lower cholesterol levels, statin use was associated with decreased risk of cardiovascular events (multivariate HR, 0.44; 95% CI, 0.27-0.71) and all-cause mortality (HR, 0.56; 95% CI, 0.36-0.88). Similar associations were observed among participants 74 years or older at baseline.
Conclusions Use of statins was associated with decreased risk of incident cardiovascular events among elderly adults. These findings lend support to the National Cholesterol Education Program guidelines, which recommend therapy for the lowering of cholesterol levels for older adults with hypercholesterolemia.
From the Cardiovascular Health Research Unit, Departments of Medicine (Drs Lemaitre and Psaty), Epidemiology (Drs Psaty and Heckbert), Health Services (Dr Psaty), and Biostatistics (Dr Kronmal), University of Washington, Seattle; the Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (Dr Newman); and the Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (Dr Burke). Dr Psaty was on the Events Committee of the Heart and Estrogen/progestin Replacement Study (HERS), a clinical trial that was sponsored by a grant from Wyeth-Ayerst Research, Radnor, Pa, and is now ended.
RELATED ARTICLE
Statin Therapy in Older Persons: Pertinent Issues
Scott M. Grundy
Arch Intern Med. 2002;162(12):1329-1331.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Rosuvastatin treatment reverses impaired coronary artery vasodilation in fructose-fed, insulin-resistant rats
Miller et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2004;287:R157-R160.
ABSTRACT
| FULL TEXT
Primary Prevention of Coronary Heart Disease in the Elderly
Dornbrook-Lavender et al.
The Annals of Pharmacotherapy 2003;37:1654-1663.
ABSTRACT
| FULL TEXT
Drug Therapy for Prevention of Recurrent Myocardial Infarction
van der Elst et al.
The Annals of Pharmacotherapy 2003;37:1465-1477.
ABSTRACT
| FULL TEXT
Improving Medication Use for Older Adults: An Integrated Research Agenda
Murray and Callahan
ANN INTERN MED 2003;139:425-429.
ABSTRACT
| FULL TEXT
Benefits of Lipid Lowering in Older Patients Without CAD
Journal Watch Cardiology 2002;2002:3-3.
FULL TEXT
Statin Therapy in Older Persons: Pertinent Issues
Grundy
Arch Intern Med 2002;162:1329-1331.
FULL TEXT
|
