Statins Benefit the Elderly as Well as the Middle-Aged

Laurie Barclay, MD

November 19, 2002

Nov. 19, 2002 — The elderly benefit from statin therapy, according to the results of a randomized controlled trial published online Nov. 19 in The Lancet and presented on Nov. 18 at the American Heart Association 75th Scientific Sessions held in Chicago, Illinois. This trial extends the age group of those likely to benefit from these agents.

"Findings of clinical trials of...statins have shown significant benefits in both primary and secondary prevention of coronary and cerebrovascular disease events. Most of this evidence comes from studies done on middle-aged men," write James Shepherd, MD, from the University of Glasgow, U.K., and colleagues. "The rationale for such treatment in people older than age 70 years, most of whom die of vascular disease, is less clear because the association between plasma cholesterol and risk of coronary artery disease diminishes with increasing age."

In the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) trial, 2,804 men and 3,000 women aged 70 to 82 years with a history of, or risk factors for, cardiovascular disease and stroke were randomized to treatment with pravastatin, 40 mg/day, or placebo. Average follow-up was 3.2 years.

Compared with the placebo group, the pravastatin group had 34% lower low-density lipoprotein cholesterol concentrations and 15% lower risk of the primary endpoint, which was a composite of coronary death, nonfatal myocardial infarction, and fatal or nonfatal stroke (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.74-0.97; P=.014; absolute risk reduction, 2%).

Pravastatin reduced coronary death and nonfatal myocardial infarction risk by 19% (HR, 0.81; 95% CI, 0.69-0.94; P=.006). Stroke risk was unaffected, but relative risk reduction for transient ischemic attack was 25% (HR, 0.75; 95% CI, 0.55-1.00; P=.051). Coronary disease mortality was 24% lower ( P=.043) in the pravastatin group than in the placebo group.

Although new cancer diagnoses were more frequent in patients receiving pravastatin than those receiving placebo (HR, 1.25; 95% CI, 1.04-1.51; P=.02), a meta-analysis of all pravastatin and all statin trials including this one showed no overall increase in risk. Pravastatin treatment did not significantly affect cognitive function and disability.

"Translation of the results of PROSPER into daily clinical practice is not straightforward," the authors write, noting that longer duration of therapy could affect benefit in terms of stroke, cognitive decline, disability, and dependency. "As in middle-aged people, statin therapy in elderly individuals reduces the risk of coronary artery disease, even in as short a period as three years.… PROSPER suggests that the strategy for vascular risk management in middle-aged people should also be applied to elderly individuals."

Bristol-Myers Squibb supported this study and has financial arrangements with some of its authors.

AHA 75th Scientific Sessions. Presented Nov. 18, 2002.
Lancet. Published online Nov. 19, 2002.

Reviewed by Gary D. Vogin, MD

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