Statins most appropriate for elderly with life-expectancy more than 2.5 years: JAMA

Guidelines recommend targeting preventive interventions toward older adults whose life expectancy is greater than the intervention's time to benefit (TTB). The TTB for statin therapy is unknown.

Hence, Lindsey C. Yourman and associates from the Division of Geriatrics and Gerontology, School of Medicine, University of California, San Diego carried out this study with the main objective to conduct a survival meta-analysis of randomized clinical trials of statins to determine the TTB for prevention of a first major adverse cardiovascular event (MACE) in adults aged 50 to 75 years.

The authors studied a total of 65 383 adults (66.3% men) with the mean age ranging from 55 to 69 years old and the mean length of follow-up ranged from 2 to 6 years.

The primary outcome was time to ARR thresholds (0.002, 0.005, and 0.010) for the first MACE, as defined by each trial. There were broad similarities in the definition of MACE across trials, with all trials including myocardial infarction and cardiovascular mortality.

Eight randomized clinical trials were conducted, and the following key findings were highlighted-

1. Only 1 of 8 studies showed that statins decreased all-cause mortality.
2. The meta-analysis results suggested that 2.5 (95% CI, 1.7-3.4) years were needed to avoid 1 MACE for 100 patients treated with a statin.
3. To prevent 1 MACE for 200 patients treated (ARR = 0.005), the TTB was 1.3 (95% CI, 1.0-1.7) years, whereas the TTB to avoid 1 MACE for 500 patients treated (ARR = 0.002) was 0.8 (95% CI, 0.5-1.0) years.

Therefore, "These findings suggest that treating 100 adults (aged 50-75 years) without known cardiovascular disease with a statin for 2.5 years prevented 1 MACE in 1 adult. Statins may help to prevent the first MACE in adults aged 50 to 75 years old if they have a life expectancy of at least 2.5 years. There is no evidence of a mortality benefit", the authors concluded.