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CLINICAL STUDY: CHRONIC CORONARY ARTERY DISEASE

Statin therapy is associated with reduced mortality across all age groups of individuals with significant coronary disease, including very elderly patients

Chloe A. Allen Maycock, RN, BSN^*, Joseph B. Muhlestein, MD, FACC^*,*, Benjamin D. Horne, MPH^*, John F. Carlquist, PhD^*, Tami L. Bair, BS^*, Robert R. Pearson, BS^*, Qunyu Li, MD^*, Jeffrey L. Anderson, MD, FACC^* Intermountain Heart Collaborative Study

^* LDS Hospital, Salt Lake City, Utah, USA
University of Utah, Salt Lake City, Utah, USA

Manuscript received February 26, 2002; revised manuscript received July 23, 2002, accepted August 1, 2002.

^* Reprint requests and correspondence: Dr. Joseph B. Muhlestein, Director of Cardiology Research, LDS Hospital, 8th Avenue & C Street, Salt Lake City, Utah, USA 84143.
ldbmuhle{at}ihc.com

OBJECTIVES: This study evaluated the effect of statin therapy on mortality in individuals with significant coronary artery disease (CAD) stratified by age.

BACKGROUND: Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) significantly reduce morbidity and mortality in individuals with CAD. Unfortunately, the large statin trials excluded individuals over 80 years old, and it is therefore unknown whether very elderly individuals benefit from statins as do younger individuals.

METHODS: A cohort of 7,220 individuals with angiographically defined significant CAD (70%) was included. Statin prescription was determined at hospital discharge. Patients were followed up for 3.3 ± 1.8 years (maximum 6.8). Patients were grouped by age (<65, 65 to 79, and 80 years) to determine whether statin therapy reduced mortality in an age-dependent manner.

RESULTS: Average age was 65 ± 12 years; 74% were male; and 31% had a postmyocardial infarction status. Overall mortality was 16%. Elderly patients were significantly less likely to receive statins than younger patients (80 years: 19.8%; 65 to 79 years: 21.1%; <65 years: 28.0%; p < 0.001). Mortality was decreased among statin recipients in all age groups: 80 years: 29.5% among patients not taking a statin versus 8.5% of those taking a statin (adjusted hazard ratio [HR] 0.50, p = 0.036); 65 to 79 years: 18.7% vs. 6.0% (HR 0.56, p < 0.001); and <65 years: 8.9% vs. 3.1% (HR 0.70, p = 0.097).

CONCLUSIONS: Statin therapy is associated with reduced mortality in all age groups of individuals with significant CAD, including very elderly individuals. Although older patients were less likely to receive statin therapy, they received a greater absolute risk reduction than younger individuals. More aggressive statin use after CAD diagnosis may be indicated, even in older patients.

Abbreviations and Acronyms   CABG   coronary artery bypass graft surgery   CAD   coronary artery disease   CHF   congestive heart failure   CI   confidence interval   CK-MB   creatine kinase-MB fraction   HR   hazard ratio   MI   myocardial infarction   PCI   percutaneous coronary intervention

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