Cost-Effectiveness of Statins in Older Adults: Further Evidence That Less Is More
Authors: Michael W. Rich
Journal: Annals of Internal Medicine (2015)

Editorials21 April 2015Cost-Effectiveness of Statins in Older Adults: Further Evidence That Less Is MoreMichael W. Rich, MDMichael W. Rich, MDFrom Washington University School of Medicine, St. Louis, Missouri.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0535 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail One of the most common conundrums faced by primary care clinicians, geriatricians, and cardiologists is whether to prescribe statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in older adults. The problem is that the many randomized clinical trials that have evaluated statins in a broad spectrum of patients have included few older adults typical of those seen in clinical practice. Accordingly, the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults focuses almost exclusively on persons aged 21 to 75 years and provides only 2 paragraphs ...References1. Stone NJ, Robinson JG, Lichtenstein AH, BaireyMerz CN, Blum CB, Eckel RH, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2889-934. [PMID: 24239923] doi:10.1016/j.jacc.2013.11.002 CrossrefMedlineGoogle Scholar2. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2015 update: a report from the American Heart Association. Circulation. 2015;131:e29-e322. [PMID: 25520374] doi:10.1161/CIR.0000000000000152 CrossrefMedlineGoogle Scholar3. Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Murray CJ; etal. Temporal trends in ischemic heart disease mortality in 21 world regions, 1980 to 2010: the Global Burden of Disease 2010 study. Circulation. 2014;129:1483-92. [PMID: 24573352] doi:10.1161/CIRCULATIONAHA.113.004042 CrossrefMedlineGoogle Scholar4. Newson RS, Felix JF, Heeringa J, Hofman A, Witteman JC, Tiemeier H. Association between serum cholesterol and noncardiovascular mortality in older age. J Am Geriatr Soc. 2011;59:1779-85. [PMID: 22091490] doi:10.1111/j.1532-5415.2011.03593.x CrossrefMedlineGoogle Scholar5. Sewright KA, Clarkson PM, Thompson PD. Statin myopathy: incidence, risk factors, and pathophysiology. Curr Atheroscler Rep. 2007;9:389-96. [PMID: 18001622] CrossrefMedlineGoogle Scholar6. Golomb BA, Evans MA, Dimsdale JE, White HL. Effects of statins on energy and fatigue with exertion: results from a randomized controlled trial [Letter]. Arch Intern Med. 2012;172:1180-2. [PMID: 22688574] doi:10.1001/archinternmed.2012.2171 CrossrefMedlineGoogle Scholar7. Lee DS, Markwardt S, Goeres L, Lee CG, Eckstrom E, Williams C; etal. Statins and physical activity in older men: the Osteoporotic Fractures in Men Study. JAMA Intern Med. 2014;174:1263-70. [PMID: 24911216] doi:10.1001/jamainternmed.2014.2266 CrossrefMedlineGoogle Scholar8. Padala KP, Padala PR, Potter JF. Statins: a case for drug withdrawal in patients with dementia [Letter]. J Am Geriatr Soc. 2010;58:1214-6. [PMID: 20722868] doi:10.1111/j.1532-5415.2010.02889.x CrossrefMedlineGoogle Scholar9. Odden MC, Pletcher MJ, Coxson PG, Thekkethala D, Guzman D, Heller D; etal. Cost-effectiveness and population impact of statins for primary prevention in adults aged 75 years or older in the United States. Ann Intern Med. 2015;162:533-41. doi:10.7326/M14-1430 LinkGoogle Scholar10. Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM, Cobbe SM, et al; PROSPER study group. PROspective Study of Pravastatin in the Elderly at Risk. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002;360:1623-30. [PMID: 12457784] MedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Washington University School of Medicine, St. Louis, Missouri.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0535.Corresponding Author: Michael W. Rich, MD, Professor of Medicine, Cardiovascular Division, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St. Louis, MO 63110; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCost-Effectiveness and Population Impact of Statins for Primary Prevention in Adults Aged 75 Years or Older in the United States Michelle C. Odden , Mark J. Pletcher , Pamela G. Coxson , Divya Thekkethala , David Guzman , David Heller , Lee Goldman , and Kirsten Bibbins-Domingo Cost-Effectiveness and Population Impact of Statins for Primary Prevention in Adults Aged 75 Years or Older in the United States Michelle C. Odden , Mark J. Pletcher , Pamela G. Coxson , Divya Thekkethala , David Guzman , David Heller , Lee Goldman , and Kirsten Bibbins-Domingo Metrics Cited ByA population-level study examining discontinuation of statins in older people with dementiaStatins for Primary Prevention in Older Adults: An Unresolved ConundrumDeprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking actionShould statins be used for primary prevention in the elderly? 21 April 2015Volume 162, Issue 8Page: 590-591KeywordsCholesterolClinical trialsDrugsElderlyHealth surveysMyocardial infarctionStatinsTreatment guidelines ePublished: 21 April 2015 Issue Published: 21 April 2015 CopyrightCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...