Highlights
- •In aged care services, statin users had much lower mortality than nonusers.
- •Statin users had lower risks of all-cause hospitalizations and falls.
- •Channeling of statin use away from frailest residents may explain study findings.
Background
Compared to randomized controlled trials, nonexperimental studies often report larger
survival benefits but higher rates of adverse events for statin use vs nonuse.
Objective
We compared characteristics of statin users and nonusers living in aged care services
and evaluated the relationships between statin use and all-cause mortality, all-cause
and fall-related hospitalizations, and number of falls during a 12-month follow-up.
Methods
A prospective cohort study of 383 residents aged ≥65 years was conducted in six Australian
aged care services. Data were obtained from electronic medical records and medication
charts and through a series of validated assessments.
Results
The greatest differences between statin users and nonusers were observed in activities
of daily living, frailty, and medication use (absolute standardized difference >0.40),
with users being less dependent and less frail but using a higher number of medications.
Statin use was associated with a decreased risk of all-cause mortality (adjusted hazard
ratio [HR] 0.58, 95% confidence interval [CI] 0.37–0.93) and hospitalizations (HR
0.67, 95% CI 0.46–0.98). After exclusion of residents unable to sit or stand, statin
use was associated with a nonsignificant increase in the risk of fall-related hospitalizations
(HR 1.47, 95% CI 0.80–2.68) but with a lower incidence of falls (incidence rate ratio
0.67, 95% CI 0.47–0.96).
Conclusions
The observed associations between statin use and the outcomes may be largely explained
by selective prescribing and deprescribing of statins and variation in likelihood
of hospitalization based on consideration of each resident's clinical and frailty
status. Randomized deprescribing trials are needed to guide statin prescribing in
this setting.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical LipidologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review.J Am Med Directors Assoc. 2015; 16: 535.e1-535.e12
- Trends in potentially inappropriate medication prescribing to nursing home patients: comparison of three cross-sectional studies.Pharmacoepidemiol Drug Saf. 2017; 26: 192-200
- The variation of statin use among nursing home residents and physicians: a cross-sectional analysis.J Am Geriatr Soc. 2017; 65: 2044-2051
- Evaluation and treatment of older patients with hypercholesterolemia: a clinical review.JAMA. 2014; 312: 1136-1144
- 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 63: 2889-2934
- Effect of Statin Treatment vs Usual Care on Primary Cardiovascular Prevention Among Older Adults: The ALLHAT-LLT Randomized Clinical Trial.JAMA Intern Med. 2017; 177: 955-965
- Secondary prevention of atherosclerotic cardiovascular disease in older adults: a scientific statement from the American Heart Association.Circulation. 2013; 128: 2422-2446
- Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial.JAMA Intern Med. 2015; 175: 691-700
- Relation of statin use and mortality in community-dwelling frail older patients with coronary artery disease.Am J Cardiol. 2016; 118: 1624-1630
- Effect of statin therapy on mortality in older adults hospitalized with coronary artery disease: a propensity-adjusted analysis.J Am Geriatr Soc. 2016; 64: 1475-1479
- Safety and effectiveness of statins for prevention of recurrent myocardial infarction in 12 156 typical older patients: a quasi-experimental study.J Gerontol A Biol Sci Med Sci. 2017; 72: 243-250
- Statin use and clinical outcomes in older men: a prospective population-based study.BMJ Open. 2013; 3 (e002333)
- Statin therapy and cognition in older people: what is the evidence?.Curr Clin Pharmacol. 2015; 10: 185-193
- Statin discontinuation in nursing home residents with advanced dementia.J Am Geriatr Soc. 2014; 62: 2095-2101
- Selective prescribing led to overestimation of the benefits of lipid-lowering drugs.J Clin Epidemiol. 2006; 59: 819-828
- Confounding control in healthcare database research: challenges and potential approaches.Med Care. 2010; 48: S114-S120
- Adverse outcomes in relation to polypharmacy in robust and frail older hospital patients.J Am Med Dir Assoc. 2016; 17 (767.e13): 767.e9
- Frailty and the prediction of negative health outcomes: a meta-analysis.J Am Med Dir Assoc. 2016; 17: 1163.e1-1163.e17
- Frailty, Hospitalization and Mortality in Residential Aged Care.J Gerontol A Biol Sci Med Sci. 2017; https://doi.org/10.1093/gerona/glx185
- Analgesic use, pain and daytime sedation in people with and without dementia in aged care facilities: a cross-sectional, multisite, epidemiological study protocol.BMJ Open. 2014; 4: e005757
- Medication management policy, practice and research in Australian residential aged care: Current and future directions.Pharmacol Res. 2017; 116: 20-28
- Frailty levels in residential aged care facilities measured using the frailty index and FRAIL-NH scale.J Am Geriatr Soc. 2016; 64: e207-e212
- Studies of illness in the aged. The index of Adl: a standardized measure of biological and psychosocial function.JAMA. 1963; 185: 914-919
- Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale.J Am Med Dir Assoc. 2003; 4: 9-15
- Performance of the dementia severity rating scale: a caregiver questionnaire for rating severity in Alzheimer disease.Alzheimer Dis Assoc Disord. 1996; 10: 31-39
- Frailty in nursing homes: the FRAIL-NH Scale.J Am Med Dir Assoc. 2015; 16: 87-89
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Polypharmacy and medication regimen complexity as risk factors for hospitalization among residents of long-term care facilities: a prospective cohort study.J Am Med Dir Assoc. 2016; 17: 1067.e1-1067.e6
- Preventing falls and harm from falls in older people: best practice guidelines for Australian Residential Aged Care Facilities.2009 (Available at:)https://www.safetyandquality.gov.au/wp-content/uploads/2012/01/Guidelines-COMM.pdfDate accessed: March 15, 2018
- A unified approach to measuring the effect size between two groups using SAS®.SAS Glob Forum. 2012; 335: 1-6
- Statin utilisation patterns in older Australians living in residential care: 1-year prevalence study.Intern Med J. 2015; 45: 106-109
- Effect of statin (HMG-Co-A-Reductase Inhibitor) use on 1-year mortality and hospitalization rates in older patients with cardiovascular disease living in nursing homes.J Am Geriatr Soc. 2002; 50: 1389-1395
- Effects of statin medication on mortality risk associated with type 2 diabetes in older persons: the population-based AGES-Reykjavik Study.BMJ Open. 2011; 1: e000132
- Bias in observational studies of prevalent users: lessons for comparative effectiveness research from a meta-analysis of statins.Am J Epidemiol. 2012; 175: 250-262
- The active comparator, new user study design in pharmacoepidemiology: historical foundations and contemporary application.Curr Epidemiol Rep. 2015; 2: 221-228
- Association of treatment for hyperlipidemia with decreased total mortality in Japanese individuals: the Yamagata (Takahata) study.J Atheroscler Thromb. 2015; 22: 1030-1039
- Interpretation of the evidence for the efficacy and safety of statin therapy.Lancet. 2016; 388: 2532-2561
- Statin-induced myopathy: a review and update.Expert Opin Drug Saf. 2011; 10: 373-387
- Effects of statins on energy and fatigue with exertion: results from a randomized controlled trial.Arch Intern Med. 2012; 172: 1180-1182
- Statin therapy, muscle function and falls risk in community-dwelling older adults.QJM. 2009; 102: 625-633
- Cognitive and physical function by statin exposure in elderly individuals following acute myocardial infarction.Clin Cardiol. 2015; 38: 455-461
- Statins and dietary and serum cholesterol are associated with increased lean mass following resistance training.J Gerontol A Biol Sci Med Sci. 2007; 62: 1164-1171
- Associations of guideline recommended medications for acute coronary syndromes with fall-related hospitalizations and cardiovascular events in older women with ischemic heart disease.J Gerontol A Biol Sci Med Sci. 2017; 72: 259-265
- Counterpoint: the treatment decision design.Am J Epidemiol. 2015; 182: 840-845
- Social stratification in the dissemination of statins after stroke in Sweden.Eur J Clin Pharmacol. 2013; 69: 1173-1180
- Systematic review of consistency between adherence to cardiovascular or diabetes medication and health literacy in older adults.Ann Pharmacother. 2012; 46: 863-872
- A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity.Am J Geriatr Pharmacother. 2011; 9: 11-23
- Specifying a target trial prevents immortal time bias and other self-inflicted injuries in observational analyses.J Clin Epidemiol. 2016; 79: 70-75
- Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial.Lancet. 2002; 360: 1623-1630
Article info
Publication history
Published online: February 24, 2018
Accepted:
February 20,
2018
Received:
October 11,
2017
Identification
Copyright
© 2018 National Lipid Association. All rights reserved.
