Some older patients benefit from statin therapy

General

Clinical Question:
In elderly patients with heart disease and elevated cholesterol, does treatment with a statin decrease mortality or cardiovascular events?

Bottom Line:
Treating 28 elderly patients with coronary heart disease (CHD) for 5 years will prevent 1 of them from dying during that period. For every 38 people treated for 5 years, 1 nonfatal myocardial infarction will be prevented; for every 58 patients treated for 5 years, 1 stroke will be prevented. (LOE = 1a)

Reference:
Afilalo J, Duque G, Steele R, Jukema JW, de Craen AJ, Eisenberg MJ. Statins for secondary prevention in elderly patients. J Am Coll Cardiol 2008;51(1):37-45.  [PMID:18174034]

Study Design:
Meta-analysis (randomized controlled trials)

Setting:
Outpatient (any)

Synopsis:
The researchers carrying out this meta-analysis searched 5 databases, including the Cochrane Central Register, as well as abstracts from cardiology conferences and reference lists of retrieved articles, and contacted authors for additional data. They identified 9 studies that compared a statin with placebo in a total of 19,569 elderly patients with pre-existing CHD. Data from the studies were independently abstracted by 2 investigators. Over an average of 4.9 years of follow-up, the rates of death due to any cause were 18.8% in placebo-treated patients and 15.6% in statin-treated patients (relative risk = 0.78; 95% CI, 0.65 - 0.89). This difference translates into 1 death prevented for every 28 patients treated for 5 years (number needed to treat (NNT) = 28; 5 - 56). Nonfatal myocardial infarction occurred in 10.5% of patients receiving placebo and 8.01% of patients receiving a statin (NNT = 38; 16 - 118). The stroke rate was also decreased, with an NNT of 58 (27 - 177).

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