Statin Use in Older Adults with Stable Atherosclerotic Cardiovascular Disease

• Published in: Journal of the American Geriatrics Society (JAGS) 2021-04, Vol.69 (4), p.979-985
• Main Authors: Spencer‐Bonilla, Gabriela, Chung, Sukyung, Sarraju, Ashish, Heidenreich, Paul, Palaniappan, Latha, Rodriguez, Fatima
• Format: Article
• Language: English
• Subjects: Aged; Arteriosclerosis; ASCVD; Atherosclerosis; Atherosclerosis - drug therapy; Atherosclerosis - epidemiology; California - epidemiology; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - epidemiology; Cholesterol; Comorbidity; Congestive heart failure; coronary artery disease; Dementia disorders; Electronic health records; Electronic medical records; Female; Guideline Adherence - standards; Health Services Misuse - statistics & numerical data; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - classification; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Longitudinal Studies; Male; Older people; Practice Guidelines as Topic; Regression analysis; Retrospective Studies; secondary prevention; Secondary Prevention - methods; Secondary Prevention - standards; Statins; stroke; Stroke - prevention & control; Underweight; Womens health
• ISSN: 0002-8614; 1532-5415; 1532-5415
• DOI: 10.1111/jgs.16975

Background/Objectives Older adults (>75 years of age) represent two‐thirds of atherosclerotic cardiovascular disease (ASCVD) deaths. The 2013 and 2018 American multi‐society cholesterol guidelines recommend using at least moderate intensity statins for older adults with ASCVD. We examined annual trends and statin prescribing patterns in a multiethnic population of older adults with ASCVD. Design Retrospective longitudinal study using electronic health record (EHR) data from 2007 to 2018. Setting A large multi‐specialty health system in Northern California. Participants A total of 24,651 adults older than 75 years with ASCVD. Measurements Statin prescriptions for older adults with known ASCVD were trended over time. Multivariable regression models were used to identify predictors of statin prescription (logistic) after controlling for relevant demographic and clinical factors. Results The study cohort included 24,651 patients older than 75 years; 48% were women. Although prescriptions for moderate/high intensity statins increased over time for adults over 75, fewer than half of the patients (45%) received moderate/high intensity statins in 2018. Women (odds ratio (OR) = 0.77; 95% confidence interval (CI) = 0.74, 0.80), patients who had heart failure (OR = 0.69; 95% CI = 0.65, 0.74), those with dementia (OR = 0.88; 95% CI = 0.82, 0.95) and patients who were underweight (OR = 0.64; 95% CI = 0.57, 0.73) were less likely to receive moderate/high intensity statins. Conclusions Despite increasing prescription rates between 2007 and 2018, guideline‐recommended statins remained underused in older adults with ASCVD, with more pronounced disparities among women and those with certain comorbidities. Future studies are warranted to examine reasons for statin underuse in older adults with ASCVD.