November 15, 2016
By David Douglas
NEW YORK (Reuters Health) - Intensity of statin therapy is associated with all-cause mortality in patients with atherosclerotic cardiovascular disease, according to new findings.
"The results support the use of high-intensity statins as recommended by the American College of Cardiology and American Heart Association, and also indicate that those older than 75 year of age may benefit from treatment with high-intensity statins," Paul A. Heidenreich of Stanford University School of Medicine in Palo Alto, California, told Reuters Health by email.
For the study, online November 9 in JAMA Cardiology, Dr. Heidenreich and colleagues studied data on more than half a million patients in the Veterans Affairs health care system.
The patients' mean age was 68.5 years and just over 10,000 were women; 29.6% received high-intensity statin therapy (e.g., atorvastatin, 40 to 80 mg); 45.6% received moderate-intensity therapy (e.g., atorvastatin 10 to 20 mg); 6.7% received low-intensity therapy (e.g., simvastatin 10 mg); and 18.2% received no statins.
After a mean follow-up of about 16 months, one-year mortality was 4.0% in the high-intensity group, 4.8% in the moderate-intensity group, 5.7% in low-intensity group and 6.6% in those not receiving statins.
After adjustment, the hazard ratio for mortality was 0.91 in the high- versus moderate-intensity group, a statistically significant difference. In addition, patients treated with maximal doses of high-intensity statins had significantly lower mortality than those receiving submaximal doses (HR, 0.90).
"The benefits of high-intensity statins were consistent for those older than 75 years compared with younger patients," the researchers note.
They add, "drug adverse effects must be considered on an individual basis and should be part of the risk discussion between a patient and a health care professional."
In an accompanying editorial, Drs. Clyde W. Yancy and Robert O. Bonow of Northwestern University, Feinberg School of Medicine, Chicago, note, "Clearly the prescription of statin therapy and its intensity remains highly individualized, but we find these findings confirmatory that high-intensity statin therapy when appropriate is beneficial for secondary prevention, and these benefits are seen even in older persons."
The study did not have commercial funding, and the authors reported no conflicts of interest.
SOURCE: bit.ly/2eW8wf2 and bit.ly/2f0z7L1
JAMA Cardiol 2016.
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