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Hydroxymethylglutaryl‐CoA Reductase Inhibitors in Older Persons with Acute Myocardial Infarction: Evidence for an Age–Statin Interaction
Author(s) -
Micale Foody JoAnne,
Rathore Saif S.,
Galusha Deron,
Masoudi Frederick A.,
Havranek Edward P.,
Radford Martha J.,
Krumholz Harlan M.
Publication year - 2006
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2005.00635.x
Subject(s) - medicine , myocardial infarction , statin , hydroxymethylglutaryl coa reductase inhibitors , cardiology , hmg coa reductase , reductase , physical therapy , enzyme , biochemistry , chemistry
OBJECTIVES: To characterize the relationship between hydroxymethylglutaryl‐CoA reductase inhibitors (statins) and outcomes in older persons with acute myocardial infarction (AMI). DESIGN: Observational study. SETTING: Acute care hospitals in the United States from April 1998 to June 2001. PARTICIPANTS: 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. MEASUREMENTS: 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). CONCLUSION: 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.