Clinical decision-making for statin treatment in older patients with coronary artery disease (CAD) is under debate, particularly in community-dwelling frail patients at high risk of death. In this retrospective observational study on 2,597 community-dwelling patients aged ≥65 years with a previous hospitalization for CAD, we estimated mortality risk assessed with the Multidimensional Prognostic Index (MPI), based on the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA), used to determine accessibility to homecare services/nursing home admission in 2005 to 2013 in the Padua Health District, Veneto, Italy. Participants were categorized as having mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) baseline mortality risk, and propensity score-adjusted hazard ratios (HRs) of 3-year mortality rate were calculated according to statin treatment in these subgroups. Greater MPI-SVaMA scores were associated with lower rates of statin treatment and higher 3-year mortality rate (MPI-SVaMA-1 = 23.4%; MPI-SVaMA-2 = 39.1%; MPI-SVaMA-3 = 76.2%). After adjusting for propensity score quintiles, statin treatment was associated with lower 3-year mortality risk irrespective of MPI-SVaMA group (HRs [95% confidence intervals] 0.45 [0.37 to 0.55], 0.44 [0.36 to 0.53], and 0.28 [0.21 to 0.39] in MPI-SVaMA-1, -2, and -3 groups, respectively [interaction test p = 0.202]). Subgroup analyses showed that statin treatment was also beneficial irrespective of age (HRs [95% confidence intervals] 0.38 [0.27 to 0.53], 0.45 [0.38 to 0.54], and 0.44 [0.37 to 0.54] in 65 to 74, 75 to 84, and ≥85 year age groups, respectively [interaction test p = 0.597]). In conclusion, in community-dwelling frail older patients with CAD, statin treatment was significantly associated with reduced 3-year mortality rate irrespective of age and multidimensional impairment, although the frailest patients were less likely to be treated with statins.

Aging Research Center Karolinska Institutet Stockholm Sweden

Department of Geriatric Care OrthoGeriatrics and Rehabilitation Frailty Area E O Galliera Hospital National Relevance and High Specialization Hospital Genoa Italy

Department of Geriatric Care OrthoGeriatrics and Rehabilitation Frailty Area E O Galliera Hospital National Relevance and High Specialization Hospital Genoa Italy; Geriatrics Unit Azienda ULSS 16 Padova S Antonio Hospital Padua Italy

Division of Geriatric Cardiology and Medicine University of Florence Florence Italy

Erasmus Medical Center Rotterdam The Netherlands

Erasmus Medical Center Rotterdam The Netherlands; University of Messina Messina Italy

Geriatric Clinic Department of Medicine University of Helsinki Helsinki Finland; Institute of Health Sciences Geriatrics University of Oulu and Oulu University Hospital Oulu Finland

Geriatrics Unit Azienda ULSS 16 Padova S Antonio Hospital Padua Italy

Health Directorate Azienda ULSS 16 Padua Italy

Hospital Universitario Ramòn y Cajal Madrid Spain

National Institute on Aging Baltimore Maryland

National Research Council Neuroscience Section Padua Italy

Neurodegenerative Disease Unit Department of Basic Medicine Neuroscience and Sense Organs University of Bari Aldo Moro Bari Italy

Unit for Aging Clinical Research Department of Medicine 2 University of Cologne Cologne Germany

Unit of Biostatistics IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo Foggia Italy

University Charles 1 Prague Czech Republic

University Hospital of Poitiers Poitiers France

See more in PubMed

Strandberg TE, Kolehmainen L, Vuorio A. Evaluation and treatment of older patients with hypercholesterolemia: a clinical review. JAMA 2014;312:1136–1144. PubMed

Afilalo J, Duque G, Steele R, Jukema JW, de Craen AJ, Eisenberg MJ. Statins for secondary prevention in elderly patients: a hierarchical Bayesian meta-analysis. J Am Coll Cardiol 2008;51:37–45. PubMed

Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, Popma JJ, Ferrucci L, Forman DE. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 2014;63:747–762. PubMed PMC

European Association for Cardiovascular Prevention & Rehabilitation; Reiner Z, Catapano AL, De Backer G, Graham I, Taskinen MR, Wiklund O, Agewall S, Alegria E, Chapman M, Durrington P, Erdine S, Halcox J, Hobbs R, Kjekshus J, Filardi PP, Riccardi G, Storey RF, Wood D; European Society of Cardiology (ESC); European Atherosclerosis Society (EAS). ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011;32:1769–1818. PubMed

Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW, Eddleman KM, Jarrett NM, LaBresh K, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, Tomaselli GF; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;129(25 Suppl 2):S1–S45. PubMed

Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK. Prognostic indices for older adults: a systematic review. JAMA 2012;307:182–192. PubMed PMC

Ferrucci L, Weilan D. Multidimensional geriatric assessment: back to the future. J Gerontol A Biol Sci Med Sci 2008;63:272–274. PubMed PMC

Pilotto A, Ferrucci L, Franceschi M, D’Ambrosio LP, Scarcelli C, Cascavilla L, Paris F, Placentino G, Seripa D, Dallapiccola B, Leandro G. Development and validation of a multidimensional prognostic index for 1-year mortality from the comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 2008;11:151–161. PubMed PMC

Pilotto A, Gallina P, Fontana A, Sancarlo D, Bazzano S, Copetti M, Maggi S, Paroni G, Marcato F, Pellegrini F, Donato D, Ferrucci L. Development and validation of a Multidimensional Prognostic Index for Mortality Based on a Standardized Multidimensional Assessment Schedule (MPI-SVaMA) in community-dwelling older subjects. J Am Med Dirassoc 2013;14:287–292. PubMed PMC

Pilotto A, Panza F, Copetti M, Simonato M, Sancarlo D, Gallina P, Strandberg T; MPI_AGE Project Investigators. Statin treatment and mortality in community-dwelling frail older patients with diabetes mellitus: a retrospective observational study. PLoS One 2015;10:e0130946. PubMed PMC

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007;335:806–808. PubMed PMC

Yanovitzky I, Zanutto E, Hornik R. Estimating causal effects of public health education campaigns using propensity score methodology. Eval Progr Plann 2005;28:209–220.

Wang R, Lagakos SW, Ware JH, Hunter DJ, Drazen JM. Statistics in Medicine. Reporting of subgroup analyses in clinical trials. N Engl J Med 2007;357:2189–2194. PubMed

Cholesterol Treatment Trialists’ (CTT) Collaboration; Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, Peto R, Barnes EH, Keech A, Simes J, Collins R. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010;376:1670–1681. PubMed PMC

Foody JM, Rathore SS, Galusha D, Masoudi FA, Havranek EP, Radford MJ, Krumholz HM. Hydroxymethylglutaryl-CoA reductase inhibitors in older persons with acute myocardial infarction: evidence for an age-statin interaction. J Am Geriatr Soc 2006;54:421–430. PubMed PMC

Gnjidic D, Le Couteur DG, Blyth FM, Travison T, Rogers K, Naganathan V, Cumming RG, Waite L, Seibel MJ, Handelsman DJ, McLachlan AJ, Hilmer SN. Statin use and clinical outcomes in older men: a prospective population-based study. BMJ Open 2013;3 10.1136/bmjopen-2012-002333. PubMed DOI PMC

Gnjidic D, Bennett A, Le Couteur DG, Blyth FM, Cumming RG, Waite L, Handelsman D, Naganathan V, Matthews S, Hilmer SN. Ischemic heart disease, prescription of optimal medical therapy and geriatric syndromes in community-dwelling older men: a population-based study. Int J Cardiol 2015;192:49–55. PubMed

Zoungas S, Curtis A, Tonkin A, McNeil J. Statins in the elderly: an answered question? Curr Opin Cardiol 2014;29:372–380. PubMed

LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Newman AB, Kooperberg CL, Black H, Curb JD, Greenland P, Woods NF; Women’s Health Initiative. Statin use and incident frailty in women aged 65 years or older: prospective findings from the Women’s Health Initiative Observational Study. J Gerontol A Biol Sci Med Sci 2008;63:369–375. PubMed

Lee DS, Markwardt S, Goeres L, Lee CG, Eckstrom E, Williams C, Fu R, Orwoll E, Cawthon PM, Stefanick ML, Mackey D, Bauer DC, Nielson CM. Statins and physical activity in older men. The Osteoporotic Fractures in Men Study. JAMA Intern Med 2014;174:1263–1270. PubMed PMC

Ko DT, Austin PC, Tu JV, Lee DS, Yun L, Alter DA. Relationship between care gaps and projected life expectancy after acute myocardial infarction. Circ Cardiovasc Qual Outcomes 2014;7:581–588. PubMed

Sanchis J, Bonanad C, Ruiz V, Fernández J, García-Blas S, Mainar L, Ventura S, Rodríguez-Borja E, Chorro FJ, Hermenegildo C, Bertomeu-González V, Núñez E, Núñez J. Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome. Am Heart J 2014;168:784–791. PubMed

Rothschild DP, Novak E, Rich MW. Effect of statin therapy on mortality in older adults hospitalized with coronary artery disease: a propensity-adjusted analysis. J Am Geriatr Soc 2016;64:1475–1479. PubMed

Siontis GC, Tzoulaki I, Ioannidis JP. Predicting death: an empirical evaluation of predictive tools for mortality. Arch Intern Med 2011;171:1721–1726. PubMed

Pilotto A, Sancarlo D, Daragjati J, Panza F. Perspective: the challenge of clinical decision-making for drug treatment in older people. The role of multidimensional assessment and prognosis. Front Med (Lausanne) 2015;1:61. PubMed PMC

Pilotto A, Rengo F, Marchionni N, Sancarlo D, Fontana A, Panza F, Ferrucci L; FIRI-SIGG Study Group. Comparing the prognostic accuracy for all-cause mortality of the frailty instruments: a multicentre 1-year follow-up in hospitalized older patients. PLoS One 2012;7:e29090. PubMed PMC

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