Abstract
Background: Despite the worldwide increase in life expectancy, individuals aged 75 years and older with an unknown history of cardiovascular disease often receive suboptimal statin treatment for primary prevention, reflecting uncertainties regarding statin efficacy and safety in this aging group. We aimed to assess the impact of statin treatment on all-cause mortality among individuals aged 75 years and older without prior cardiovascular diagnoses. Methods: This retrospective study utilized real-world data from a large cohort of individuals aged 75 years and older who were treated as outpatients in or were admitted to the Tel Aviv Sourasky Medical Center. Extracted variables included demographic details, Charlson Comorbidity Index (CCI), chronic medication regimens, mortality outcomes and blood test results (high-density lipoprotein, low-density lipoprotein and creatinine). Patients with a prior diagnosis of angina, myocardial infarction or stroke were excluded from the study. Results: A total of 98,502 patients were included in the study, of whom 37,171 (mean age 80.67 ± 4.73 years) were treated with statins and 6804 (18.3%) of the latter patients were aged 85 years and above. The majority of the statin-treated patients (72.6%) had received high-intensity statins. The non-statin-treated group comprised 61,331 subjects with a mean age of 82.69 ± 5.77 years, of whom 19,253 (31.39%) were aged 85 years and above. The risk of all-cause mortality was significantly lower in the statin-treated group compared to the non-statin-treated group (adjusted odds ratio [aOR] 0.715, 95% confidence interval [CI] [0.671-0.761], p < 0.001). This trend persisted after stratification for age 85 years and above (aOR 0.7, 95% CI [0.606-0.809], p < 0.001), and for a low CCI (≤4) or a high CCI (>4) score (aOR 0.766, 95% CI [0.708-0.803]; aOR 0.648, 95% CI [0.585-0.717], respectively, p < 0.001). Conclusions: Provision of statin therapy contributes to a reduction in risk of all-cause mortality in individuals aged 75 years and above who have an unknown history of cardiovascular disease, regardless of the type of statin or the patient's CCI score.