title: Safety and Effectiveness of Statins for Prevention of Recurrent Myocardial Infarction in 12 156 Typical Older Patients: A Quasi-Experimental Study.
abstract: There is limited evidence on statin risk and effectiveness for patients aged 80+. We estimated risk of recurrent myocardial infarction, muscle-related and other adverse events, and statin-related incremental costs in "real-world" older patients treated with statins versus no statins.
  
  
  
  We used primary care electronic medical records from the UK Clinical Practice Research Datalink. Subhazard ratios (competing risk of death) for myocardial infarction recurrence (primary end point), falls, fractures, ischemic stroke, and dementia, and hazard ratios (Cox) for all-cause mortality were used to compare older (60+) statin users and 1:1 propensity-score-matched controls (n = 12,156). Participants were followed-up for 10 years.
  
  
  
  Mean age was 76.5±9.2 years; 45.5% were women. Statins were associated with near significant reduction in myocardial infarction recurrence (subhazard ratio = 0.84, 0.69-1.02, p = .073), with protective effect in the 60-79 age group (0.73, 0.57-0.94) but a nonsignificant result in the 80+ group (1.06, 0.78-1.44; age interaction p = .094). No significant associations were found for stroke or dementia. Data suggest an increased risk of falls (1.36, 1.17-1.60) and fractures (1.33, 1.04-1.69) in the first 2 years of treatment, particularly in the 80+ group. Treatment was associated with lower all-cause mortality. Statin use was associated with health care cost savings in the 60-79 group but higher costs in the 80+ group.
  
  
  
  Estimates of statin effectiveness for the prevention of recurrent myocardial infarction in patients aged 60-79 years were similar to trial results, but more evidence is needed in the older group. There may be an excess of falls and fractures in very old patients, which deserves further investigation.
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, UK. a.ble@exeter.ac.uk.|School for Public Health Research, National Institute for Health Research, UK.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ble
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Institute of Health Service Research, University of Exeter Medical School, UK.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Hughes
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, UK.|School for Public Health Research, National Institute for Health Research, UK.
authors.forename: Joao
authors.initials: J
authors.lastname: Delgado
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, UK.|Healthcare for Older People, Royal Devon and Exeter NHS Foundation Trust, UK.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Masoli
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, UK.|School for Public Health Research, National Institute for Health Research, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Bowman
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: Zirk-Sadowski
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Institute of Health Service Research, University of Exeter Medical School, UK.
authors.forename: Ruben E
authors.initials: RE
authors.lastname: Mujica Mota
authors.affiliation: Health Statistics, Institute of Health Research, University of Exeter Medical School, UK.
authors.forename: William E
authors.initials: WE
authors.lastname: Henley
authors.affiliation: Epidemiology and Public Health, Institute of Biomedical and Clinical Science, University of Exeter Medical School, UK.|School for Public Health Research, National Institute for Health Research, UK.
authors.forename: David
authors.initials: D
authors.lastname: Melzer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D065228:Non-Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Falls; Fractures; Myocardial infarction; Older; Statins