Effectiveness of statins for primary prevention in the elderly - a propensity score matched cohort study

Abstract Background Cardiovascular disease remains a leading cause of morbidity and mortality in older adults, yet the role of statins for primary prevention in the elderly remains debated. While statins are widely prescribed for primary prevention in younger populations, their benefits and risks in advanced age groups require further investigation due to altered risk-benefit profiles, polypharmacy concerns, and limited representation in randomized trials. Purpose This study aimed to evaluate the effectiveness of statins for primary prevention of cardiovascular events and mortality in adults aged 70–84 years. Methods We utilized TriNetX, a global federated health research network, to identify new statin users for primary prevention, stratified into three age groups: 70–74, 75–79, and 80–84 years. Control cohorts comprised patients prescribed paracetamol without prior statin use, matched by the same age categories. Patients with end-stage diseases were excluded. Propensity score matching (PSM) was employed to balance demographics, comorbidities, cardiovascular risk factors, and social determinants of health. The primary outcomes were overall mortality and major adverse cardiovascular events (MACE)—a composite of acute myocardial infarction (ICD-10 I21), percutaneous coronary intervention (36.06–0.7), coronary artery bypass grafting (0210–13; 0270–73), and ischemic stroke (I63). LDL-C levels served as a positive control outcome, while burns and corrosions (T20–32) were used as a negative control outcome (NCO). Outcomes were analyzed from 1 year post-prescription, with follow-up extending up to 10 years, using Kaplan–Meier survival analysis and Cox regression models. Results Among patients aged 70–74 years (n = 148,837 per matched cohort), statin initiation was associated with: lower LDL-C levels (85.7 ± 33 vs. 94.3 ± 36 mg/dL, p 0.0001), reduced mortality (HR 0.82, 95% CI 0.80–0.84), and reduced MACE (HR 0.93, 95% CI 0.90–0.95) with no change in NCO (HR 0.99, 95% CI 0.89–1.09) Among patients aged 75–79 years (n = 98,194 per matched cohort), statin use was associated with: lower LDL-C levels (84.6 vs. 92.9 mg/dL, p 0.0001), reduced mortality (HR 0.84, 95% CI 0.82–0.86), and reduced MACE (HR 0.94, 95% CI 0.91–0.97) with no change in NCO (HR 1.00, 95% CI 0.98–1.03) Among patients aged 80–84 years (n = 39,766 per matched cohort), statin initiation was associated with: lower LDL-C levels (82.7 vs. 91.9 mg/dL, p 0.0001), reduced mortality (HR 0.86, 95% CI 0.83–0.89) a trend toward reduced MACE (HR 0.96, 95% CI 0.91–1.01) with no change in NCO (HR 0.96, 95% CI 0.75–1.22) Conclusions In this large real-world study, statin initiation was associated with lower LDL-C levels, reduced mortality, and a significant reduction in MACE across all elderly age groups. These findings support the use of statins for primary prevention in older adults, including those aged 80–84 years, where data have been particularly limited.