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Association between Statins Prescribed for Primary and Secondary Prevention and Major Adverse Cardiac Events among Older Adults with Frailty: A Systematic Review

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Abstract

Background

Statins reduce the risk of major adverse cardiovascular events (MACE), however their clinical benefit for primary and secondary prevention among older adults with frailty is uncertain. This systematic review investigates whether statins prescribed for primary and secondary prevention are associated with reduced MACE among adults aged ≥ 65 years with frailty.

Methods

We conducted a systematic review of studies published between 1 January 1952 and 1 January 2019 in the MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library and International Pharmaceutical Abstracts databases. Studies that investigated the effect of statins on MACE among adults ≥ 65 years of age with a validated frailty assessment were included. Data were extracted from the papers as per a prepublished protocol, PROSPERO: CRD42019127486. Risk of bias was assessed using the Cochrane Risk of Bias in Non-Randomised Studies of Interventions tool.

Results

Six cohort studies fulfilled the inclusion criteria; there were no randomised clinical trials. Among studies evaluating the association between statins for primary and secondary prevention and mortality, one study found statins were associated with reduced mortality (hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.37–0.93), while another study found they were not (HR 0.81, 95% CI 0.61–1.08). Furthermore, one study of statins used for secondary prevention found they were associated with reduced mortality (HR 0.28, 95% CI 0.21–0.39). No studies investigated the effect of statins for primary prevention or the effect of statins on the frequency of MACE.

Conclusion

This review identified only observational evidence that among older people with frailty, statins are associated with reduced mortality when prescribed for secondary prevention, and an absence of evidence evaluating statin therapy for primary prevention. Randomised trial data are needed to better inform the use of statins among older adults living with frailty.

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Acknowledgements

The authors would like to thank Deirdre Andre, Research Librarian at the University of Leeds, for her assistance with develo** the search strategy and conducting the searches.

Author information

Authors and Affiliations

  1. Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK

    Matthew Hale, Oliver Todd, Harriet Callaghan & Andrew Clegg

  2. Department of Geriatrics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK

    Matthew Hale, Harriet Callaghan & Andrew Clegg

  3. School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK

    Hadar Zaman & David Mehdizadeh

  4. NIHR Yorkshire and Humber Patient Safety Translational Research Centre (YHPSTRC), Bradford, UK

    David Mehdizadeh

  5. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK

    Chris P. Gale

  6. Leeds Institute for Data Analytics, University of Leeds, Leeds, UK

    Chris P. Gale

  7. Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK

    Chris P. Gale

Authors
  1. Matthew Hale
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  7. Andrew Clegg
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MH, HZ, DM, OT and HC. The first draft of the manuscript was written by MH and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Matthew Hale.

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Funding

MH is funded by an Academic Clinical Fellowship from the National Institute for Health Research; OT is funded by a doctoral fellowship from the Dunhill Medical Trust, UK (RTF107/0117); and AC is part-funded by the National Institute for Health Research Applied Research Collaboration, Yorkshire and Humber. The views expressed in this publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the National Institute for Health Research or the Department of Health and Social Care.

Conflict of interest

Matthew Hale, Hadar Zaman, David Mehdizadeh, Oliver Todd, Harriet Callaghan, Chris P. Gale and Andrew Clegg have no conflicts of interest to declare that may be relevant to the contents of this manuscript.

Availability of data and material

The search strategy utilised is published in Online Resource 2.

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Hale, M., Zaman, H., Mehdizadeh, D. et al. Association between Statins Prescribed for Primary and Secondary Prevention and Major Adverse Cardiac Events among Older Adults with Frailty: A Systematic Review. Drugs Aging 37, 787–799 (2020). https://doi.org/10.1007/s40266-020-00798-3

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