Hydroxymethylglutaryl-CoA reductase inhibitors in older persons with acute myocardial infarction: evidence for an age-statin interaction.
OBJECTIVE
To characterize the relationship between hydroxymethylglutaryl-CoA reductase inhibitors (statins) and outcomes in older persons with acute myocardial infarction (AMI).


METHODS
Observational study.


METHODS
Acute care hospitals in the United States from April 1998 to June 2001.


METHODS
Medicare patients aged 65 and older with a principal discharge diagnosis of AMI (N=65,020) who did and did not receive a discharge prescription for statins.


METHODS
The primary outcome of interest was all-cause mortality at 3 years after discharge.


RESULTS
Of 23,013 patients with AMI assessed, 5,513 (24.0%) were receiving a statin at discharge. Nearly 40% of eligible patients (n=8,452) were aged 80 and older, of whom 1,310 (15.5%) were receiving a statin at discharge. In a multivariable model taking into account demographic, clinical, physician and hospital characteristics, and propensity score, discharge statin therapy was associated with significantly lower 3-year mortality (hazard ratio (HR)=0.89 (95% confidence interval (CI)=0.83-0.96)). In an analysis stratified by age, discharge statins were associated with lower mortality in patients younger than 80 (HR=0.84, 95% CI=0.76-0.92) but not in those aged 80 and older (HR=0.97, 95% CI=0.87-1.09).


CONCLUSIONS
Statin therapy is associated with lower mortality in older patients with AMI younger than 80 but not in those aged 80 and older, as a group. This finding questions whether statin efficacy data in younger patients can be broadly applied to the very old and indicates the need for further study of this group.
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520, USA. joanne.foody@yale.edu
JoAnne Micale
JM
Foody
Saif S
SS
Rathore
Deron
D
Galusha
Frederick A
FA
Masoudi
Edward P
EP
Havranek
Martha J
MJ
Radford
Harlan M
HM
Krumholz
D000367:Age Factors; D000369:Aged, 80 and over; D000069059:Atorvastatin; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D011307:Drug Prescriptions; D005229:Fatty Acids, Monounsaturated / Q000627:therapeutic use; D005260:Female; D000077340:Fluvastatin; D005500:Follow-Up Studies; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007211:Indoles / Q000627:therapeutic use; D008148:Lovastatin / Q000627:therapeutic use; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D016017:Odds Ratio; D017035:Pravastatin / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
D008078:Cholesterol, LDL; D005229:Fatty Acids, Monounsaturated; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D011725:Pyridines; D011758:Pyrroles; D000077340:Fluvastatin; D008148:Lovastatin; D000069059:Atorvastatin; C086276:cerivastatin; D017035:Pravastatin