Among patients aged 80 or older, high adherence to statins after a myocardial infarction appears to be associated with improved survival. Promoting medication adherence interventions to individuals in this age range may extend survival.
Use of statins to reduce cardiovascular disease (CVD) risks requires careful consideration when managing patients aged 80 years and older. Clinicians must weigh the potential beneﬁts of cardiovascular protection with statins against possible adverse effects and drug-drug interactions. These decisions can be complex because patients in this age range are particularly vulnerable due to a variety of reasons. Further complicating matters is that patients aged 80 and older are an under-represented group in large randomized trials. This has led to a lack of data on the beneﬁts of statins in this age group.
“Adherence presents a considerable challenge in older patients because many of them are prescribed multiple medications,” explains Mingsum Lee, MD, PhD. “Declining cognitive function, lack of social support, and concerns for adverse effects also contribute to poor adherence. These are important issues when caring for survivors of myocardial infarction because statins are a mainstay of treatment.”
Taking a Deeper Look
For a study published in the Journal of the American Geriatrics Society, Dr. Lee and colleagues sought to describe patterns of statin adherence in patients aged 80 and older using a large multicenter cohort of diverse adults. “In addition to describing these patterns, we wanted to identify factors associated with suboptimal adherence to statins and determine the potential impact of suboptimal statin adherence on mortality,” Dr. Lee says.
For the retrospective population-based study, the authors looked at more than 5,600 patients aged 80 and older who were hospitalized with a principal diagnosis of acute myocardial infarction over a 10-year period (2006-2018). Statin adherence was based on proportion of days covered (PDC), and adherence levels were categorized as high (PDC 80% or higher), partial (PDC 40% or higher and lower than 80%), and low (PDC lower than 40%).
Examining Key Findings
Results of the study showed that nearly 70% of patients aged 80 or older were highly adherent to statin therapy and about 20% were partially adherent. “Importantly, we observed gender and racial disparities in statin adherence,” says Dr. Lee (Table). “Women and patients from minority racial and ethnic groups were less likely to be adherent to statin therapy.” In addition, the study showed that hyperlipidemia increased the odds of high statin adherence by 17%, whereas heart failure decreased the odds of high statin adherence by 15%.
Regarding mortality, the greatest survival rates were observed among patients with the highest statin adherence. Both low and partial adherence were associated with increased mortality. These trends remained even after adjusting for demographics, comorbidities, and exposure to other cardiac medications. “Overall, poor adherence to statin therapy was associated with signiﬁcantly worse long-term survival,” says Dr. Lee.
As life expectancy continuing to rise in the United States, people aged 80 or older have become one of the fastest-growing subpopulations in the country. Cardiovascular risk factors are common in this age group, and they carry a disproportionate burden of CVD. National guidelines note that it is reasonable to consider using statins in patients aged 75 and older to reduce CVD risks after careful consideration of risk-reduction beneﬁts, potential adverse effects and drug-drug interactions, and patient preferences.
The study by Dr. Lee and colleagues supports considering statins and promoting medication adherence, even in patients aged 80 or older. “Gender and racial disparities in statin adherence remain true for patients in this age range,” Dr. Lee says. “Nonadherence may be an important contributor to disparities in cardiovascular outcomes based on race, ethnicity, and gender.”
To enhance patient outcomes, Dr. Lee recommends efforts be made to educate patients aged 80 and older on the risks and benefits of statins. “In addition, it is important to provided medication reminders, improve coordination of care, simplify dosing regimens, and discuss costs of statins whenever possible,” she says. “These efforts have been promising in younger patient populations and may be beneficial when managing adults aged 80 and older. Implementation of interventions to improve adherence may improve cardiovascular mortality in this population.”
Phan DQ, Lam B, Hekimian A, Wee D, Zadegan R, Lee MS. Statin adherence and mortality in patients aged 80 years and older after acute myocardial infarction. J Am Geriatr Soc. 2019 Jun 17 [Epub ahead of print]. Available at: https://onlinelibrary.wiley.com/doi/pdf/10.1111/jgs.16037 and at: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.16037?referrer_access_token=LnEw90V1Gkh6fsfBz2hMOYta6bR2k8jH0KrdpFOxC66ON8Xx8AKwfxUaIejDRmGhMC4lbudMxUzWMxjATrbH-9PfVCZbzWzRYiOMdYY4y2_vf82omIh_7o21eXuGKSIet7h8R3n7VDndq–xUJy9fg%3D%3D.
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