How Common is Statin Use in the Oldest Old?
There is a lack of evidence surrounding the efficacy of statins in the oldest old (≥ 80 years of age). As such, there is controversy surrounding use of statins in this population. We sought to evaluate the prevalence of statin use in the oldest old worldwide to understand the scope of this issue. We searched PubMed and grey literature over the last 5 years. Studies had to report the prevalence of statin use in adults ≥ 80 years of age. The first author performed screening and extracted data. Our search produced 1870 hits; 14 articles were considered eligible. We found three studies of nursing home residents, eight studies of community-dwelling patients and three studies in the combined population (i.e., both community-dwelling patients and nursing home residents). The prevalence of statin use ranged from 17 to 39% in nursing home residents, 12 to 59% for community-dwelling patients and 18 to 45% in combined populations. Beyond age 80 years, the prevalence of statin use appeared to decrease with advancing age. Statin use was more common as secondary prevention compared with primary prevention. The prevalence of statin use in the oldest old has increased over recent decades. The increase in prevalence appears to be more pronounced in the oldest old compared with younger old, as reported by two studies. Statins are widely used in the oldest old despite the lack of evidence in this population. Given how common statin use is in the oldest old, clinical evidence surrounding their efficacy in this group is urgently needed to guide appropriate use and shared decision-making.
WT conceived the article, performed the search, interpreted data, drafted and revised the manuscript. AP, JBN, PH, and DEJ interpreted data, drafted the article, and provided critical revisions. All authors gave final approval for publication and are accountable for all aspects of the work.
Compliance with Ethical Standards
No external funds were used in the preparation of this manuscript.
Conflict of interest
Wade Thompson, Anton Pottegård, Jesper Bo Nielsen, Peter Haastrup, and Dorte Ejg Jarbøl declare no potential conflicts of interest that might be relevant to the contents of this manuscript.
- 1.Naci H, Brugts JJ, Fleurence R, Tsoi B, Toor H, Ades A. Comparative benefits of statins in the primary and secondary prevention of major coronary events and all-cause mortality: a network meta-analysis of placebo-controlled and active-comparator trials. Eur J Prev Cardiol. 2013;20(4):641–57. https://doi.org/10.1177/2047487313480435.CrossRefPubMedGoogle Scholar
- 8.Han BH, Sutin D, Williamson JD, et al. Effect of statin treatment vs usual care on primary cardiovascular prevention among older adults: the ALLHAT-LLT randomized clinical trial. JAMA Intern Med. 2017;177(7):955–65. https://doi.org/10.1001/jamainternmed.2017.1442.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Johansen M. Statin use in very elderly individuals, 1999–2012. JAMA Intern Med. 2015;7(October):25–6. https://doi.org/10.1001/jamainternmed.2015.4302.Author.CrossRefGoogle Scholar
- 27.Strandberg TE, Urtamo A, Kähärä J, Strandberg AY, Pitkälä KH, Kautiainen H. Statin treatment is associated with a neutral effect on health-related quality of life among community-dwelling octogenarian men. J Gerontol A Biol Sci Med Sci. 2018. https://doi.org/10.1093/gerona/gly073.CrossRefPubMedGoogle Scholar
- 30.Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. Circulation. 2014;129(25 suppl 2):S1–45. https://doi.org/10.1161/01.cir.0000437738.63853.7a.CrossRefPubMedGoogle Scholar