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Health & Medicine for Senior Citizens

Seniors 60-Plus Most Affected by New Expanded Guidelines for Statin Use

Almost 13 million more Americans to be eligible for statins; 8.3 million would be people over the age of 60, says Duke Medicine study

March 20, 2014 – An additional 12.8 million in U.S. may soon be taking statins to prevent cardiovascular disease, including stroke, due to new guidelines expanding the criteria for use to include people with an elevated 10-year risk. The most affected will be seniors between the ages of 60 and 75 without cardiovascular disease - 87.4 percent of men and 53.6 percent of women will fall within the new guidelines.

The increase is much more pronounced among adults free of cardiovascular disease who are over age 60, with 77 percent recommended for statin use under the new guidelines vs. 48 percent under the previous standards. This contrasts with a modest increase from 27 percent to 30 percent among U.S. adults between the ages of 40 and 60.

Under the earlier guidelines, only about 30.4 percent of men between the ages of 60-75 were recommended for statin use. This takes a gigantic jump to 87.4 percent. Similarly for healthy women in this age group, those recommended for preventive statin use are projected to rise from 21.2 percent to 53.6 percent.

The analysis of health data published online March 19, 2014, in the New England Journal of Medicine,  for the first time quantify the impact of the American Heart Association's new guidelines (see story in sidebar), which were issued in November and generated both controversy and speculation about who should be given a prescription for statins. The elevated risk criteria will be based on a risk-assessment score.

 

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New Statin Guidelines Not Supportive of Starting Therapy for Elderly Over 75

The few data available did not clearly support initiation of high-intensity statin therapy for secondary prevention in individuals 75 and older

Nov. 13, 2013 – The new clinical practice guideline released yesterday for the use of statins in the treatment of blood cholesterol in people at high risk for cardiovascular diseases caused by atherosclerosis, or hardening and narrowing of the arteries, that can lead to heart attack, stroke or death, identified four “major groups” to target and at least two of them exclude seniors over age 75. It does, however, “support the continuation of statins beyond 75 years of age in persons who are already taking and tolerating these drugs.” Read more...


 
 

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"The biggest surprise of the research was the age-dependent split for those affected by the new guidelines," said lead author Michael J. Pencina, Ph.D., professor of biostatistics at Duke Clinical Research Institute.

"We anticipated that the impact would be age-dependent, but not to the degree observed. The changes for both men and women in the older age groups where huge compared to those between the ages of 40 and 60."

The DCRI-led research team determined that the new guidelines could result in 49 percent of U.S. adults ages 40-75 being recommended for statin therapy, an increase from 38 percent.

Overall, of the 12.8 million additional U.S. adults recommended for statin use under the new guidelines, 10.4 million are people who would be prescribed the drugs for preventive care. Of those preventive users, 8.3 million would be people over the age of 60.

"We sought to do a principled, scientific study to try to answer how the new guidelines might affect statin use, particularly as they focused eligibility on patients with an increased risk of developing cardiovascular disease," said Pencina.

"By our estimate, there might be an uptake in usage as a result of the guidelines, from 43.2 million people to 56 million, which is nearly half of the U.S. population between the ages of 40 and 75."

Pencina and colleagues from McGill University and Boston University used the National Health and Nutrition Examination Surveys (NHANES) for their analysis, focusing on 3,773 participants between the ages of 40-75 who had provided detailed medical information, including fasting cholesterol levels from blood tests.

The analysis also projects that an estimated 1.6 million adults previously eligible for statins under the old guidelines would no longer be candidates under the new standards. This group included primarily younger adults with elevated cholesterol but low 10-year risk of cardiovascular disease.

Pencina said an important limitation of the study is the necessary assumption that the new guidelines would be followed to the letter; in real life, people may be recommended for statins but decline to start the therapy.

"Recommendations are just that – recommendations," Pencina said. "These guidelines correctly call for a thorough discussion between the doctor and patient about the risks and benefits of statins. It's not like everybody who meets the guidelines should all of a sudden go on statins."

Notes:

In addition to Pencina, study authors from Duke include Ann Marie Navar-Boggan, Benjamin Neely and Eric D. Peterson; with Ralph B. D'Agostino from Boston University; Ken Williams of KenAnCo Biostatistics; and Allan D. Sniderman from McGill University.

The Duke Clinical Research Institute funded the study, along with grants from M. Jean de Granprι and Louis & Sylvia Vogel.

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