Does statin use render survival benefit in frail patients?

Statins, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-Co-A) reductase inhibitors, are a common cardiovascular (CV) preventive medication prescribed to elderly patients and those in long-term care facilities, primarily to reduce the risk of atherosclerosis-related cardiovascular disease (CVD). Statins are reported to be effective up to roughly 75 years of age, and when used in addition to lifestyle changes, they bring about a substantial lowering in CVD prevalence. However, in the elderly (>75 years), there is no clarity on recommendations and are determined mainly by shared decision-making and concerns for frailty, polypharmacy, and overall life expectancy.

Frailty is a complex syndrome that increases with age and predisposes the elderly to adverse outcomes, including mortality. Considering the survival benefits of statins in frail older patients, Avilash Mondal, Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA, USA, and colleagues aimed to determine whether statins can reduce mortality in the elderly or not by conducting a meta-analysis.

For this purpose, the researchers conducted a comprehensive search of online databases until September 2022 to identify studies reporting mortality outcomes with statin therapy in adults aged 75 with a validated frailty assessment. Calculation of the pooled odds ratio was done for all-cause mortality using a random effects model. Leave-one-out method was used for sensitivity analysis.

The researchers reported the following findings:

• Five studies (2013-2022) comprising 14324 people were included (three prospective and two retrospectives, Males: 49%, Mean follow-up duration: 4.7 years), and 41.6% were frail. 52.7% of patients were on a moderate-dose/no-statin, while 47.2% took a high-dose statin.
• Non-statin users were older (83.35 versus 81.5) than users. Frail patients often had diabetes, hypertension, hyperlipidemia, a history of Stroke/MI and dementia.
• High-dose atorvastatin was the most used statin. Pooled analysis revealed that statins lower all-cause mortality in elderly adults, however, the association was not significant (OR 0.67).

"Our findings suggest that statin therapy does not provide significant survival benefits in frail older adults," the researchers wrote. "Although the pooled analysis revealed a trend towards lower mortality in statin users, this was not statistically significant."

The lack of a significant association may be due to the relatively small number of studies included in the analysis, and the heterogeneity of the populations studied.

"There is a need for further prospective studies to guide statin use among frail older adults for survival benefits," they concluded.

Reference:

Mondal, A., Li, A., Edusa, S., Gogineni, A., Karipineni, S., Abdelhafez, S., Nalluri, S. D., Meka, G. G., Bawa, J., Puli, S., Venkata, V. S., Vyas, A., Jain, A., & Desai, R. (2023). Does Statin Use in Frail Patients Provide Survival Benefits? Insights From a Meta-Analysis. Current Problems in Cardiology, 102038. https://doi.org/10.1016/j.cpcardiol.2023.102038