Author + information
- Received March 9, 2020
- Revision received May 1, 2020
- Accepted May 4, 2020
- Published online June 29, 2020.
- Zhen Zhou, MDa,∗ (, )
- Richard Ofori-Asenso, PhDb,c,
- Andrea J. Curtis, PhDb,
- Monique Breslin, PhDa,
- Rory Wolfe, PhDb,
- John J. McNeil, PhDb,
- Anne M. Murray, MD, MScd,e,
- Michael E. Ernst, PharmDf,g,
- Christopher M. Reid, PhDb,h,
- Jessica E. Lockery, MB, BSb,
- Robyn L. Woods, PhDb,
- Andrew M. Tonkin, MB, BS, MDb and
- Mark R. Nelson, PhDa
- aMenzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- bDepartment of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- cCopenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- dBerman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Division of Geriatrics, Department of Medicine, Hennepin HealthCare, Minneapolis, Minnesota
- eUniversity of Minnesota, Minneapolis, Minnesota
- fDepartment of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa
- gDepartment of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- hSchool of Public Health, Curtin University, Perth, Western Australia, Australia
- ↵∗Address for correspondence:
Dr. Zhen Zhou, Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia.
Background There is clinical uncertainty regarding the benefits and harms of prescribing statins in healthy subjects ≥70 years of age.
Objectives The aim of this study was to examine the association among statins, dementia-free and disability-free survival, and cardiovascular disease (CVD) among healthy older adults using data from the ASPREE (Aspirin in Reducing Events in the Elderly) trial.
Methods ASPREE was a randomized trial of 19,114 community-dwelling persons in Australia and the United States ≥65 years of age and free of documented CVD, dementia, and disability. Data were collected for those ≥70 years of age, and participants who took statins at baseline were compared with those who did not using Cox proportional hazards regression with inverse probability weighting. The primary outcome, referred to as “disability-free survival,” was a composite of all-cause mortality, dementia, or persistent physical disability. Other outcomes included the individual components of the composite outcome, major adverse cardiovascular events, fatal CVD, myocardial infarction, and stroke.
Results Of the 18,096 included participants (median age 74.2 years, 56.0% women), 5,629 took statins at baseline. Over a median follow-up period of 4.7 years, baseline statin use was not associated with disability-free survival or with the risk for all-cause mortality or dementia. However, it was associated with lower risks for physical disability and all cardiovascular outcomes.
Conclusions Among healthy community-dwelling adults ≥70 years of age, statin use may be beneficial for preventing physical disability and CVD but not beneficial for prolonging disability-free survival or avoiding death or dementia. Future clinical trials are needed to confirm these findings.
The ASPREE trial was supported by a grant (U01AG029824) from the National Institute on Aging and the National Cancer Institute at the National Institutes of Health, by grants (334047 and 1127060) from the National Health and Medical Research Council (NHMRC) of Australia, and by Monash University and the Victorian Cancer Agency. Dr. Tonkin has received research support or honoraria from Merck, Pfizer, and Amgen; has received materials from Bayer in the ASPREE trial; and has received grant support from the National Health and Medical Research Council for the STAREE trial. Dr. Nelson has received honoraria from Sanofi and Amgen; has received materials from Bayer in ASPREE; and has received NHMRC grant support for STAREE. Dr. Reid is funded through an NHMRC Principal Research Fellowship. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received March 9, 2020.
- Revision received May 1, 2020.
- Accepted May 4, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.