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Effectiveness of statins for the primary prevention of cardiovascular disease in the Asian elderly population

  • Yu-Wen Lin
    Affiliations
    Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Chi-Chuan Wang
    Affiliations
    Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan

    School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
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  • Chau-Chung Wu
    Affiliations
    Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Department of Primary Care Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Yih-Ting Hsu
    Affiliations
    Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Fang-Ju Lin
    Correspondence
    Corresponding author at: Graduate Institute of Clinical Pharmacy & School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
    Affiliations
    Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan

    School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
    Search for articles by this author
Published:November 23, 2022DOI:https://doi.org/10.1016/j.ijcard.2022.11.031

      Highlights

      • Statin therapy could be beneficial for primary prevention of cardiovascular disease in elderly Asians.
      • Compared with statin non-users, statin users had significantly lower risks of MACE and all-cause mortality.
      • The outcome assessment was further confirmed by marginal structural models to appropriately adjust for the confounding effect of time-varying LDL-C levels.

      Abstract

      Background

      Population aging is a global trend, and the elderly have a higher risk of atherosclerotic cardiovascular disease (ASCVD) and related mortality. Statins have been observed to reduce cardiovascular events in patients with ASCVD. However, compared with secondary prevention, the benefits of statins for primary prevention are undetermined among the elderly.

      Aims

      This study aimed to evaluate the effectiveness of statins in an elderly population without a history of cardiovascular disease (CVD).

      Methods

      The study was carried out using the National Taiwan University Hospital Integrated Medical Database and the National Health Insurance Research Database in Taiwan. Patients aged 65 years and older without a history of CVD were identified between 1 February 2008 and 31 December 2015. New statin users were 1:4 matched to nonusers based on certain variables. The risks of major adverse cardiovascular events (MACEs) and all-cause mortality were estimated using Cox proportional hazards models. Further, we applied marginal structural models to account for time-varying low-density lipoprotein cholesterol (LDL-C) levels.

      Results

      A total of 2761 new statin users and 9503 nonusers were selected after matching; the mean age was 71.8 years, and 63% were women. At a median follow-up of 4.8 years, statin use was associated with reduced risk of MACEs (hazard ratio [HR]: 0.75; 95% confidence interval [CI], 0.52–0.98) and mortality (HR: 0.72, 95% CI: 0.55–0.93) when accounting for time-varying LDL-C. No significant differences in effect were detected between subgroups.

      Conclusion

      Statin use could be beneficial for the primary prevention of CVD in elderly Asians.

      Keywords

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