1008-189 Atorvastatin therapy reduces markers of myocardial damage after percutaneous coronary interventions? Preliminary data from a randomized study (original) (raw)
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Canadian Medical Association Journal, 2005
Clinical trials have shown the benefits of statins after acute myocardial infarction (AMI). However, it is unclear whether different statins exert a similar effect in reducing the incidence of recurrent AMI and death when used in clinical practice. We conducted a retrospective cohort study (1997-2002) to compare 5 statins using data from medical administrative databases in 3 provinces (Quebec, Ontario and British Columbia). We included patients aged 65 years and over who were discharged alive after their first AMI-related hospital stay and who began statin treatment within 90 days after discharge. The primary end point was the combined outcome of recurrent AMI or death from any cause. The secondary end point was death from any cause. Adjusted hazard ratios (HRs) for each statin compared with atorvastatin as the reference drug were estimated using Cox proportional hazards regression analysis. A total of 18,637 patients were prescribed atorvastatin (n = 6420), pravastatin (n = 4480), simvastatin (n = 5518), lovastatin (n = 1736) or fluvastatin (n = 483). Users of different statins showed similar baseline characteristics and patterns of statin use. The adjusted HRs (and 95% confidence intervals) for the combined outcome of AMI or death showed that each statin had similar effects when compared with atorvastatin: pravastatin 1.00 (0.90-1.11), simvastatin 1.01 (0.91-1.12), lovastatin 1.09 (0.95-1.24) and fluvastatin 1.01 (0.80-1.27). The results did not change when death alone was the end point, nor did they change after adjustment for initial daily dose or after censoring of patients who switched or stopped the initial statin treatment. Our results suggest that, under current usage, statins are equally effective for secondary prevention in elderly patients after AMI.
Impact of High-Dose Atorvastatin in Coronary Heart Disease Patients Age 65 to 78 Years
Clinical Cardiology, 2009
High-dose statin therapy may be underutilized in aged patients due to doubts about efficacy and safety. Hypothesis: To investigate outcomes and safety in patients aged 65-78 years compared with patients aged <65 years in the ALLIANCE study. Methods: A total of 2,442 stable coronary heart disease (CHD) patients with dyslipidemia were randomized to either aggressive treatment (low-density lipoprotein cholesterol titration goal of <80 mg/dL or maximum 80 mg/d of atorvastatin) or usual care (continuation of baseline lipid-lowering therapy, with changes and laboratory analyses directed by treating physicians). Results: A total of 1,001 patients aged 65-78 years were followed for a median period of 53.9 mo. Older, aggressively treated atorvastatin patients experienced a 27% relative risk reduction for the primary composite endpoint of adverse cardiovascular outcomes (hazard ratio [HR]: 0.73; 95% confidence intervals [CI]: 0.57-0.94; p = 0.016). In addition, significant risk reductions were observed for nonfatal myocardial infarction (MI; HR: 0.43; 95% CI: 0.23-0.79; p = 0.006), cardiac revascularization (HR: 0.67; 95% CI: 0.48-0.93; p = 0.017), and the combined endpoint of cardiac death and nonfatal MI (HR: 0.48; 95% CI: 0.32-0.72; p = 0.001). The rate of significant liver transaminase elevations in atorvastatin patients was low and not age related. There were no cases of rhabdomyolysis. The rate of study discontinuations due to serious adverse events was higher in patients aged 65-78 years than in those younger than 65 years, but was similar between the treatment groups. Conclusions: Our data support the efficacy and safety of aggressive lipid management with atorvastatin in older CHD patients.
Journal of the American Geriatrics Society, 2019
To explore the effect of initiating statins for secondary prevention after a first myocardial infarction (MI) in patients aged 80 years and older. DESIGN: Retrospective cohort study. SETTING: Clinical Practice Research Datalink (1999-2016). PARTICIPANTS: Patients, aged 65 years and older, hospitalized after a first MI without a statin prescription in the year before hospitalization. The age group of 65 to 80 years was included to compare our results to current evidence. MEASUREMENTS: The primary outcome was a composite of recurrent MI, stroke, and cardiovascular mortality; and the secondary outcome was all-cause mortality. A timevarying Cox model was used to account for statin prescription over time. We compared at least 2 years of statin prescription time with untreated and less than 2 years of prescription time. Analyses were adjusted for potential confounders. The number needed to treat (NNT) was calculated based on the adjusted hazard ratios (HRs) and corrected for deaths during the first 2 years of follow-up. RESULTS: A total of 9020 patients were included. Among the 3900 patients aged 80 years and older, 2 years of statin prescriptions resulted in a lower risk of the composite outcome (adjusted HR = 0.81; 95% confidence interval [CI] = 0.66-0.99) and of all-cause mortality (adjusted HR = 0.84; 95% CI = 0.73-0.97). During 4.5 years of median follow-up, the NNT for prevention of the primary outcome was 59; and for mortality, the NNT was 36. Correcting for 36.2% deaths during the first 2 years increased the NNT on the primary outcome to 93 and to 61 on all-cause mortality. CONCLUSION: Our data support statin initiation after a first MI in patients aged 80 years and older if continued for at least 2 years. Especially in patients with a low risk of 2-year mortality, statins should be considered.
Archives of Medical Science, 2013
A b s t r a c t I In nt tr ro od du uc ct ti io on n: : The effect of cardiovascular disease (CVD) prevention measures aimed at elderly patients requires further evidence. We investigated the effect of statin treatment (targeted to achieve guideline goals) on CVD outcomes in different age groups to determine whether statins are more beneficial in the elderly. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : The primary endpoint of this post hoc analysis of the GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study (n = 1,600 patients with established coronary heart disease (CHD), mean follow-up 3 years) was the absolute and relative CVD event (a composite of death, myocardial infarction, revascularization, unstable angina, heart failure and stroke) risk reduction in age quartiles (each n = 200). Patients on "structured care" with atorvastatin (n = 800) followed up by the university clinic and treated to lipid goal were compared with the corresponding quartiles on "usual care" (n = 800) followed up by specialists or general practitioners of the patient's choice outside the hospital. R Re es su ul lt ts s: : In the elderly (mean age 69 ±4 and 70 ±3 years in the "structured" and "usual care", respectively) the absolute CVD event reduction between "structured" and "usual care" was 16.5% (p < 0.0001), while in the younger patients (mean age 51 ±3 years and 52 ±3 years in the "structured" and "usual care", respectively) this was 8.5% (p = 0.016); relative risk reduction (RRR) 60% (p < 0.0001) vs. 42% respectively (p = 0.001). The elderly had higher rates of chronic kidney disease and higher uric acid levels, plus an increased prevalence of diabetes, metabolic syndrome and non-alcoholic fatty liver disease. These factors might contribute to the increased CVD risk in older patients. C Co on nc cl lu us si io on ns s: : All age groups benefited from statin treatment, but the elderly on "structured care" had a greater absolute and relative CVD risk reduction than the younger patients when compared with the corresponding patients assigned to "usual care". These findings suggest that we should not deprive older patients of CVD prevention treatment and lipid target achievement.
Internal Medicine, 2022
Objective In an extremely aging society, it is beneficial to reconsider the value of medical treatment for extremely elderly patients. We therefore focused on the efficacy of statin therapy in extremely elderly patients. This study investigated the efficacy of statins for secondary prevention in patients over 75 years old. Methods This prospective multicenter registry included 1,676 consecutive extremely elderly patients with coronary artery disease who underwent successful percutaneous coronary intervention (PCI). The patients were followed up clinically for up to three years or until the occurrence of major adverse cardiac events (MACEs), defined as a composite of all-cause death and non-fatal myocardial infarction. Using propensity score methodology to eliminate selection bias, in a 1:1 matching ratio, we selected 466 pairs of patients for the analysis. Results During the median follow-up period of 25 months, MACEs occurred in 176 patients. The Kaplan-Meier analysis showed that statin treatment correlated with a lower probability of initial MACE occurrences within 30 days compared with no statin treatment (log-rank test, p<0.001). According to a landmark analysis at day 30, statin treatment still showed consistent effectiveness for reducing MACE occurrence during the follow up period (p=0.04). A multivariable Cox hazard analysis showed that statin therapy significantly reduced MACE occurrence (hazard ratio 0.55 [0.40-0.75], p<0.001). In the stratification analysis, statin therapy was especially beneficial in patients without symptomatic heart failure. Conclusion Statins were effective in preventing MACEs in extremely elderly patients after PCI.
Statin therapy and cardiovascular outcomes after coronary
In this issue of Atherosclerosis, Natsuaki et al. reported the effects of statin treatment on major adverse cardiovascular (CV) events [MACE: composite of CV death, myocardial infarction (MI) and stroke] in patients 80 years undergoing first coronary revascularization i.e. percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in the CREDO-Kyoto (Coronary REvascularization Demonstrating Outcome study in Kyoto) PCI/CABG registry cohort-2. Briefly, a total of 14,834 patients were included in the present study (PCI: n ¼ 12,716 and isolated CABG: n ¼ 2118) and were divided into 2 groups according to age: the super-elder (80 years, age range ¼ 80e101; n ¼ 2017 patients) and the non-super-elder group (<80 years, age range 16e79; n ¼ 12,817 patients) [1]. The study population was further categorized by statin use: statin group (super-elder: n ¼ 765, nonsuper-elder: n ¼ 6523) and no-statin group (super-elder: n ¼ 1252, non-super-elder: n ¼ 6294). With regard to baseline characteristics, heart failure, prior and acute MI, prior stroke, hypertension, female gender, anemia and multivessel disease were more prevalent in the super-elder group, whereas diabetes, current
The American Journal of Cardiology, 2009
The efficacy and safety of atorvastatin (80 mg/day) versus simvastatin (20 to 40 mg/day) in older (age >65 years) versus younger (<65 years) patients were assessed in a prespecified secondary analysis of the 8,888 patients with myocardial infarction in the IDEAL trial, a randomized open-label study. Several cardiovascular end points were evaluated, including the occurrence of a first major coronary event (MCE; nonfatal myocardial infarction, coronary heart disease death, or resuscitated cardiac arrest), the primary end point of the trial, and occurrence of any cardiovascular event (MCE, stroke, revascularization, unstable angina, congestive heart failure, and peripheral artery disease). Although there were no significant interactions between age and treatment, the magnitude of effect in favor of atorvastatin was higher in younger versus older patients (occurrence of first MCE, hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.66 to 0.98; and HR 0.95, 95% CI 0.80 to 1.15, respectively; occurrence of any cardiovascular (CV) event, HR 0.80, 95% CI 0.71 to 0.89; and HR 0.88, 95% CI 0.79 to 0.99, respectively). These results were likely influenced by adherence, which was lower in older patients and those receiving atorvastatin compared with those receiving simvastatin. Rates of any reported serious adverse event were higher in older patients, but did not differ between the 2 statin groups. In conclusion, except for any CV events in the older group, significant reductions in primary and secondary end points were observed only in patients years of age. The safety of atorvastatin (80 mg) and simvastatin (20 to 40 mg) was similar in patients aged <65 and >65 years with stable coronary disease. © 2009 Elsevier Inc. (Am J Cardiol 2009;103:577-582)
The American Journal of Geriatric Pharmacotherapy, 2007
This review concluded that there was limited evidence to suggest that high-risk elderly patients without a known risk of coronary artery disease may benefit from statin treatment, but more trials were needed. Despite the poor reporting of the review methods, the authors' cautious conclusions and recommendations for further research appear reliable given the limitations of the included data. Authors' objectives To review the efficacy, safety and current recommendations for the use of statins in the prevention of cardiovascular disease in older adults.