Background: Trials examining statin benefit often exclude elderly patients over age 75 years; thus specific guidelines on statin initiation for this group are lacking. Among U.S. veterans, there is a growing elderly population with a high prevalence of diabetes and cardiovascular (CV) disease. We sought to characterize which elderly diabetic and nondiabetic U.S. veterans initiated a statin and the related all-cause mortality risk.
Methods: We identified 204,217 veterans who were not on statin at baseline (2004-2006) and were more than 75 years old at the time of initial lipid measurement between 2006-2008. Cox models were used to examine associations of statin initiation within 6 months of lipid measurement with all-cause mortality after adjustment for demographics, Charlson Index, CV comorbidites, liver disease, cancer, smoking, and kidney disease.
Results: Cohort mean age was 81±4 years, and comprised 2% female, 8% blacks, 20% diabetics, and 43% with CV disease. Statin initiation was more common in diabetics vs. nondiabetics (11% vs. 7%, respectively) and decreased with higher age. Among diabetics, there was little difference in CV comorbidities for statin initiation vs. not; whereas in nondiabetics, statin initiators were more likely to have ischemic heart disease. For both groups, statin initiators had higher triglyceride and LDL levels. Simvastatin was the most frequently prescribed statin in both groups (over 80%), followed by atorvastatin (3%) in diabetics. Over median follow-up of 9 (7,10) years, statin initiation was associated with a lower adjusted all-cause mortality risk in diabetics (HR: 0.91, 95% CI: 0.88, 0.95), with a similar association in nondiabetics (HR: 0.95, 95% CI: 0.92, 0.97).
Conclusions: Elderly U.S. veterans with diabetes who initiated statin therapy had a moderately lower risk of all-cause mortality. Further analyses will examine considerations for additional predictors and differences in cause of death.
M. Soohoo: None. E. Streja: None.
U.S. Department of Veteran Affairs
