Preventive cardiology for the aging population: how can we better design clinical trials of statins?

ABSTRACT

Introduction

Older adults form a fast-increasing proportion of the world population. However, gains in increasing quantity of life have not been accompanied by similar gains in quality of life. Older people frequently experience frailty, memory problems, and chronic diseases including cardiovascular disease (CVD) and neurodegenerative diseases. Recent trials have demonstrated the efficacy of anti-hypertensive therapy in older populations but failed to show benefits for aspirin.

Area covered

Statins clearly reduce CVD events in middle-aged populations. There seems to be evidence that the effect is similar in primary prevention older populations based on meta-analyses mainly from sub-groups in large trials, but this becomes less clear with increasing age. However, given differences in drug metabolism and possibly efficacy, competing co-morbidities, their effects on mortality, disability, and dementia in this age group remain to be determined.

Expert opinion

Two large trials are now underway to clarify the role of statin therapy in people aged over 70 years using endpoints of mortality, disability, and neurocognitive endpoints as well as standard cardiovascular disease outcomes. They may provide also provide more evidence on how to approach the over 80 year age group.

KEYWORDS:

• Statin
• cardiovascular disease
• disability
• dementia
• ploy-pharmacy
• elderly

Article highlights

• Most data on older patients are derived from sub-groups of younger individuals recruited to clinical trials.

• Older patients are more likely to have other co-morbidities and be subject to polypharmacy and may have different drug metabolism compared with younger individuals.

• Statin therapy has been associated with benefits of non-cardiovascular chronic diseases in cohort studies in older patients.

• Standard cardiovascular event endpoints are not the only appropriate measure of effectiveness in this age group.

• Two randomized controlled clinical trials of statin therapy in primary prevention are underway in this population.

Declaration of interest

A Wierzbicki is an investigator in the STAREE trial. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A peer reviewer on this manuscript has collaborated with several companies marketing CVD drugs. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.