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Densham E, Youssef E, Ferguson O, Winter R. The effect of statins on falls and physical activity in people aged 65 and older: A systematic review. Eur J Clin Pharmacol 2024; 80:657-668. [PMID: 38353691 DOI: 10.1007/s00228-024-03632-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/18/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Statins are commonly prescribed medications with recognised side effects including muscle weakness. Despite this, little is known about their effect on the physical activity and falls risk in the older population. This paper aims to explore the relationship between statin use and the physical activity and falls risk in adults aged 65 and older. METHODS MEDLINE, Embase, CINAHL and PsycINFO were searched on 21/11/2022 to obtain relevant articles. Data considered appropriate included that relating to muscle strength, grip strength, gait speed, balance and falls incidence. Reference and citation searches were performed to identify further relevant papers, and all eligible articles were subject to a Critical Appraisal Skills Programme (CASP) to assess potential bias. With the data being highly heterogeneous, no attempt to measure effect size was made and a narrative synthesis approach was used. The review proposal was registered with PROSPERO: CRD42022366159. RESULTS Twenty articles were included. Data were inconsistent throughout, with the overall trend suggesting no significant negative effects of statins on the parameters of physical activity, or on falls risk. This was especially true in matched and adjusted cohorts, where potential confounders had been accounted for. CONCLUSION This review did not identify a relationship between statin use and physical activity and falls risk in people aged 65 years and older. Ultimately, the risks and benefits of every medication should be considered in the context of each individual.
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Affiliation(s)
| | | | | | - Rebecca Winter
- Brighton and Sussex Medical School, Brighton, UK
- University Hospitals Sussex, Brighton, UK
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Yoshida Y, Ishizaki T, Masui Y, Hori N, Inagaki H, Ito K, Ogawa M, Yasumoto S, Arai Y, Kamide K, Ikebe K, Gondo Y. Effect of number of medications on the risk of falls among community-dwelling older adults: A 3-year follow-up of the SONIC study. Geriatr Gerontol Int 2024; 24 Suppl 1:306-310. [PMID: 38185808 DOI: 10.1111/ggi.14760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024]
Abstract
AIM This study examined the association between the number of prescribed medications and falls among community-dwelling older adults. METHODS We conducted a geriatric comprehensive health-checkup on community-dwelling adults aged 69-91 years who participated in the Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians study. The final analysis of this study included 1,076 participants with complete data. The participants were divided into four groups based on the number of medications at baseline: 0, 1, 2-4, and ≥5. At the 3-year follow-up, the participants were asked whether they had fallen in the past year. Multivariable logistic regression analysis was performed to assess the relationship between the number of medications taken and falls after adjusting for confounding factors. RESULTS The prevalence rates of falls were 10.5%, 18.2%, 18.3%, and 19.8% in the no-medication, one-medication, comedication, and polypharmacy groups, respectively. In the one-medication prescription group, 59% of prescriptions were for fall-risk-increasing drugs (FRID). Multivariable analysis showed a significantly higher incidence of falls in the one-medication group (adjusted odds ratio [OR], 1.91; 95% confidence interval [CI], 1.04-3.54), co-medication (OR, 1.89; 95% CI, 1.09-3.29), and polypharmacy groups (OR, 1.94; 95% CI, 1.09-3.45) than in the no-medication group. CONCLUSIONS The study showed that polypharmacy, as well as just taking one medication, can affect the occurrence of falls. This suggests that in addition to the number of medications and polypharmacy, the type of medication, such as FRID, affects the risk of falls. Therefore, pharmacotherapy should consider the risk of falls in older adults when prescribing medications. Geriatr Gerontol Int 2024; 24: 306-310.
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Affiliation(s)
- Yuko Yoshida
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Tatsuro Ishizaki
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yukie Masui
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Noriko Hori
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hiroki Inagaki
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Kae Ito
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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3
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Mondal A, Li A, Edusa S, Gogineni A, Karipineni S, Abdelhafez S, Nalluri SD, Meka GG, Bawa J, Puli S, Venkata VS, Vyas A, Jain A, Desai R. Does Statin Use in Frail Patients Provide Survival Benefits? Insights From a Meta-Analysis. Curr Probl Cardiol 2024; 49:102038. [PMID: 37597795 DOI: 10.1016/j.cpcardiol.2023.102038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/21/2023]
Abstract
Frailty is a complex syndrome that increases with age and predisposes older adults to adverse outcomes, including mortality. Statins are proven to lower the risk of atherosclerotic cardiovascular disease, but there is limited data on their survival benefit in frail older people. This meta-analysis was conducted to determine whether statins can lower mortality in frail persons. A comprehensive search of PubMed, Google Scholar, and SCOPUS was conducted until September 2022 to identify studies reporting mortality outcomes with statin therapy in adults aged 75 with a validated frailty assessment. The pooled odds ratio for all-cause mortality was calculated using a random effects model. Leave-one-out method was used for sensitivity analysis. Of 5 studies (2013-2022) included (Total = 14,324, 3 prospective and 2 retrospectives, Males: 49%, Mean follow-up duration: 4.7 years), 41.6% (5971/14,324) were frail. 52.7% of patients were on a moderate-dose/no-statin, while 47.2% took a high-dose statin. Nonstatin users were older (83.35 vs 81.5) than users. Frail patients often had diabetes, hypertension, hyperlipidemia, a history of Stroke/MI, and dementia. High-dose atorvastatin was the most used statin. Pooled analysis revealed that statins lower all-cause mortality in elderly adults, however, the association was not significant (OR 0.67, 95% CI 0.38-1.18; P = 0.17). The meta-analysis demonstrated that using statins to reduce mortality in frail patients does not appear justifiable. Further prospective studies are needed to guide statin use among frail older adults for survival benefits.
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Affiliation(s)
- Avilash Mondal
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA
| | - Aobo Li
- Department of Internal Medicine, Beijing Anzhen Hospital, Beijing, China
| | - Samuel Edusa
- Department of Internal Medicine, Samalla Clinic Ltd., New Gbawe - Accra, Ghana
| | - Anurag Gogineni
- Department of Medicine, Nagarjuna Hospital, Vijayawada, Andhra Pradesh, India
| | | | | | | | - Gautham Gosh Meka
- Department of Medicine, Andhra Medical College, Vishakhapatnam, Andhra Pradesh, India
| | - Jerrin Bawa
- Department of Internal Medicine, Flushing Hospital, NY
| | - Srikanth Puli
- Department of Hospital Medicine, Cheshire Medical Center, Dartmouth-Hitchcock, Keene, NH
| | | | - Ankit Vyas
- Vascular Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | - Akhil Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Nowak MM, Niemczyk M, Florczyk M, Kurzyna M, Pączek L. Effect of Statins on All-Cause Mortality in Adults: A Systematic Review and Meta-Analysis of Propensity Score-Matched Studies. J Clin Med 2022; 11:jcm11195643. [PMID: 36233511 PMCID: PMC9572734 DOI: 10.3390/jcm11195643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022] Open
Abstract
Statins are lipid-lowering medications used for the prevention of cardiovascular disease (CVD), but the pleiotropic effects of statins might be beneficial in other chronic diseases. This meta-analysis investigated the association between statin use and mortality in different chronic conditions. Eligible studies were real-world studies that compared all-cause mortality over at least 12 months between propensity score-matched statin users and non-users. Overall, 54 studies were included: 21 in CVD, 6 in chronic kidney disease, 6 in chronic inflammatory diseases, 3 in cancer, and 18 in other diseases. The risk of all-cause mortality was significantly reduced in statin users (hazard ratio: 0.72, 95% confidence interval: 0.66−0.76). The reduction in mortality risk was similar in CVD studies (0.73, 0.66−0.76) and non-CVD studies (0.70, 0.67−0.79). There were no significant differences in the risk reduction between cohorts with different diseases (p = 0.179). The greatest mortality reduction was seen in studies from Asia (0.61, 0.61−0.73) and the lowest in studies from North America (0.78, 0.73−0.83) and Australia (0.78, 0.62−0.97). There was a significant heterogeneity (I2 = 95%, tau2 = 0.029, p < 0.01). In conclusion, statin use was associated with a significantly reduced risk of all-cause mortality in real-world cohorts with CVD and non-CVD.
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Affiliation(s)
- Marcin M. Nowak
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at the European Health Center, 05-400 Otwock, Poland
- Correspondence:
| | - Mariusz Niemczyk
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland
| | - Michał Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at the European Health Center, 05-400 Otwock, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology at the European Health Center, 05-400 Otwock, Poland
| | - Leszek Pączek
- Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland
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Li S, Hao X, Yuan K, Zhang F, Xun L, Hao Q, Zhang Q, Xie Y. Impact of High-Dose Perindopril on Cardiac Function and Angiotensin Converting Enzyme 2/Ang-(1-9)/Ang-(1-7) in Rabbits with Ischemic Cardiac Dysfunction. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aim: To investigate the impact of high-dose of perindopril on cardiac function and ACE2/AT2R pathway in rabbits with ischemic cardiac dysfunction. Methods: The thirty rabbits with ischemic cardiac dysfunction were divided into high-dose group (Perindopril, 2 mg/kg/d),
low-dose group (Perindopril, 0.66 mg/kg/d), and control groups (Saline, 2 ml/kg/d) by a random number table. After four weeks, we measured the cardiac function, The level of Ang-(1-7) and Ang-(1-9), mRNA expression level of ACE2 and AT2R. Results: The results showed that high dose and
low dose of perindopril could improve cardiac function (p < 0.001), and high-dose perindopril had more significant improvement (p = 0.041). After treatment, in high-dose group, mRNA level of ACE2, AT2R in myocardium (p < 0.001) and Ang-(1-9) level in serum (p = 0.012)
were higher than low-dose group, while Ang-(1-7) levels in serum didn’t show a significant difference (p = 0.829). LVEF and serum Ang-(1-9) were significantly correlated (p = 0.002), LVEF and ACE2 (p = 0.001), LVEF and AT2R (p = 0.007); however, it was no
correlation between LVEF and serum Ang-(1-7) (p = 0.067). Conclusion: A high-dose of perindopril could improve ischemic cardiac dysfunction by ACE2/Ang-(1-9)/Ang-(1-7) pathway.
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Affiliation(s)
- Shuren Li
- The First Department of Heart Center, Hebei General Hospital, Shijiazhuang, 050000, China
| | - Xiao Hao
- The First Department of Heart Center, Hebei General Hospital, Shijiazhuang, 050000, China
| | - Kexin Yuan
- The First Department of Heart Center, Hebei General Hospital, Shijiazhuang, 050000, China
| | - Feifei Zhang
- The First Department of Heart Center, Hebei General Hospital, Shijiazhuang, 050000, China
| | - Liying Xun
- The First Department of Heart Center, Hebei General Hospital, Shijiazhuang, 050000, China
| | - Qingqing Hao
- The First Department of Heart Center, Hebei General Hospital, Shijiazhuang, 050000, China
| | - Qianhui Zhang
- The First Department of Heart Center, Hebei General Hospital, Shijiazhuang, 050000, China
| | - Yuetao Xie
- The First Department of Heart Center, Hebei General Hospital, Shijiazhuang, 050000, China
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Early statin use and cardiovascular outcomes after myocardial infarction: A population-based case-control study. Atherosclerosis 2022; 354:8-14. [DOI: 10.1016/j.atherosclerosis.2022.06.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/03/2022] [Accepted: 06/17/2022] [Indexed: 11/21/2022]
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Viscogliosi G, Donfrancesco C, Lo Noce C, Vanuzzo D, Carle F, Giampaoli S, Palmieri L. Prevalence and Correlates of Statin Underuse for Secondary Prevention of Cardiovascular Disease in Older Adults 65-79 Years of Age: The Italian Health Examination Survey 2008-2012. Rejuvenation Res 2020; 23:394-400. [PMID: 32008438 DOI: 10.1089/rej.2019.2268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Limited data are available on the prevalence and correlates of statin use for secondary cardiovascular (CV) prevention in the older adult population. We used data of older adults (65-79 years) with established atherosclerotic CV disease from the cross-sectional Italian Health Examination Survey 2008-2012 to address this issue. Lifestyles, CV risk factors, chronic diseases, and therapies were assessed using standardized procedures. A comprehensive geriatric assessment was performed to evaluate cognitive function, disability in basic activities of daily living/instrumental activities of daily living, mobility, and polypharmacy. Multiple regression analyses were performed to identify independent correlates of statin use. A total of 392 participants (mean age 72.1 ± 4.4 years, 61.5% men) were considered for this analysis. Coronary heart disease was identified in 67.1% of participants, cerebrovascular disease in 23.5%, and peripheral artery disease (PAD) in 18.1%. One hundred ninety (48.5%) were statin users. By multiple regression analysis, functional disability (odds ratio [OR] = 0.81; 95% confidence interval [CI] = 0.71-0.92; p = 0.002), cognitive impairment (OR = 0.87; 95% CI = 0.78-0.98; p = 0.018), and polypharmacy (OR = 0.86; 95% CI = 0.75-0.98; p = 0.035) predicted statin nonuse, whereas having hypertension (OR = 1.19; 95% CI = 1.05-1.34; p = 0.005), diabetes mellitus (OR = 1.14; 95% CI = 1.03-1.27; p = 0.013), or a previous myocardial revascularization (OR = 1.31; 95% CI = 1.16-1.48; p < 0.001) predicted statin use. Significant interaction terms were observed between cerebrovascular disease, PAD, cognitive impairment, and disability in predicting statin nonuse. Statin underuse in older adults aged 65-79 years with CV disease, and thus suboptimal secondary CV prevention, is highly prevalent despite current guidelines and recommendations. Common geriatric conditions are associated with statin nonuse. Such results support the need for improving the awareness of statin treatment for secondary CV prevention.
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Affiliation(s)
- Giovanni Viscogliosi
- Department of Cardiovascular, Dysmetabolic and Ageing-Associated Diseases, National Institute of Health, Rome, Italy.,Department of Epidemiology, Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Chiara Donfrancesco
- Department of Cardiovascular, Dysmetabolic and Ageing-Associated Diseases, National Institute of Health, Rome, Italy
| | - Cinzia Lo Noce
- Department of Cardiovascular, Dysmetabolic and Ageing-Associated Diseases, National Institute of Health, Rome, Italy
| | - Diego Vanuzzo
- Department of Cardiology, National Association Hospital Cardiologists, Florence, Italy
| | - Flavia Carle
- Department of Epidemiology, Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Simona Giampaoli
- Department of Cardiovascular, Dysmetabolic and Ageing-Associated Diseases, National Institute of Health, Rome, Italy
| | - Luigi Palmieri
- Department of Cardiovascular, Dysmetabolic and Ageing-Associated Diseases, National Institute of Health, Rome, Italy
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Luotola K, Jyväkorpi S, Urtamo A, Pitkälä KH, Kivimäki M, Strandberg TE. Statin treatment, phenotypic frailty and mortality among community-dwelling octogenarian men: the HBS cohort. Age Ageing 2020; 49:258-263. [PMID: 31755909 DOI: 10.1093/ageing/afz138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/19/2019] [Accepted: 10/01/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND statin treatment has increased also among people aged 80 years and over, but adverse effects potentially promoting frailty and loss of resilience are frequent concerns. METHODS in the Helsinki Businessmen Study, men born in 1919-34 (original n = 3,490) have been followed up since the 1960s. In 2011, a random subcohort of home-living survivors (n = 525) was assessed using questionnaires and clinical (including identification of phenotypic frailty) and laboratory examinations. A 7-year mortality follow-up ensued. RESULTS we compared 259 current statin users (median age 82 years, interquartile range 80-85 years) with 266 non-users (83; 80-86 years). Statin users had significantly more multimorbidity than non-users (prevalencies 72.1% and 50.4%, respectively, P < 0.0001) and worse glucose status than non-users (prevalencies of diabetes 19.0% and 9.4%, respectively, P = 0.0008). However, there was no difference in phenotypic frailty (10.7% versus 11.2%, P = 0.27), and statin users had higher plasma prealbumin level than non-users (mean levels 257.9 and 246.3 mg/L, respectively, P = 0.034 adjusted for age, body mass index and C-reactive protein) implying better nutritional status. Despite morbidity difference, age-adjusted 7-year mortality was not different between the two groups (98 and 103 men among users and non-users of statins, respectively, hazard ratio 0.96, 95% confidence interval 0.72-1.30). CONCLUSIONS our study suggests that male octogenarian statin users preserved resilience and survival despite multimorbidity, and this may be associated with better nutritional status among statin users.
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Affiliation(s)
- Kari Luotola
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
| | - Satu Jyväkorpi
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
| | - Annele Urtamo
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
| | - Kaisu H Pitkälä
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
| | - Mika Kivimäki
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
- Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Timo E Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
- University of Oulu, Center for Life Course Health Research, Oulu, Finland
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9
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Cost-effectiveness of statin therapy for secondary prevention among patients with coronary artery disease and baseline LDL-C 70-100 mg/dL in Taiwan. J Formos Med Assoc 2020; 119:907-916. [PMID: 32081563 DOI: 10.1016/j.jfma.2020.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/06/2019] [Accepted: 01/19/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The recommended target low-density lipoprotein cholesterol (LDL-C) level for coronary artery disease (CAD) patients has been lowered from 100 to 70 mg/dL in several clinical guidelines for secondary prevention. We aimed to assess whether initiating statin treatment in CAD patients with baseline LDL-C 70-100 mg/dL in Taiwan could be cost-effective. METHODS A Markov model was developed to simulate a hypothetical cohort of CAD patients with a baseline LDL-C level of 90 mg/dL. The incidence and recurrence of MI and stroke related to specific LDL-C levels as well as the statin effect, mortality rate, and health state utilities were obtained from the literature. The direct medical costs and rate of fatal events were derived from the national claims database. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life years (QALYs) was calculated, and sensitivity analyses were performed. RESULTS Moderate-intensity statin use, a treatment regimen expected to achieve LDL <70 mg/dL in the base case, resulted in a net gain of 562 QALYs but with an additional expenditure of $11.4 million per 10,000 patients over ten years. The ICER was $20,288 per QALY gained. The probabilities of being cost-effective at willingness-to-pay thresholds of one and three gross domestic product per capita ($24,329 in 2017) per QALY were 51.1% and 94.2%, respectively. Annual drug cost was the most influential factor on the ICER. CONCLUSION Lowering the target LDL-C level from 100 to 70 mg/dL among treatment-naïve CAD patients could be cost-effective given the health benefits of preventing cardiovascular events and deaths.
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Lefeber GJ, Koek HL, Souverein PC, Bouvy ML, de Boer A, Knol W. Statins After Myocardial Infarction in the Oldest: A Cohort Study in the Clinical Practice Research Datalink Database. J Am Geriatr Soc 2020; 68:329-336. [PMID: 31647578 PMCID: PMC7028025 DOI: 10.1111/jgs.16227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To explore the effect of initiating statins for secondary prevention after a first myocardial infarction (MI) in patients aged 80 years and older. DESIGN Retrospective cohort study. SETTING Clinical Practice Research Datalink (1999-2016). PARTICIPANTS Patients, aged 65 years and older, hospitalized after a first MI without a statin prescription in the year before hospitalization. The age group of 65 to 80 years was included to compare our results to current evidence. MEASUREMENTS The primary outcome was a composite of recurrent MI, stroke, and cardiovascular mortality; and the secondary outcome was all-cause mortality. A time-varying Cox model was used to account for statin prescription over time. We compared at least 2 years of statin prescription time with untreated and less than 2 years of prescription time. Analyses were adjusted for potential confounders. The number needed to treat (NNT) was calculated based on the adjusted hazard ratios (HRs) and corrected for deaths during the first 2 years of follow-up. RESULTS A total of 9020 patients were included. Among the 3900 patients aged 80 years and older, 2 years of statin prescriptions resulted in a lower risk of the composite outcome (adjusted HR = 0.81; 95% confidence interval [CI] = 0.66-0.99) and of all-cause mortality (adjusted HR = 0.84; 95% CI = 0.73-0.97). During 4.5 years of median follow-up, the NNT for prevention of the primary outcome was 59; and for mortality, the NNT was 36. Correcting for 36.2% deaths during the first 2 years increased the NNT on the primary outcome to 93 and to 61 on all-cause mortality. CONCLUSION Our data support statin initiation after a first MI in patients aged 80 years and older if continued for at least 2 years. Especially in patients with a low risk of 2-year mortality, statins should be considered. J Am Geriatr Soc 68:329-336, 2020.
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Affiliation(s)
- Geert J. Lefeber
- Department of Geriatrics, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Expertise Centre Pharmacotherapy in Old PersonsUtrechtThe Netherlands
| | - Huiberdina L. Koek
- Department of Geriatrics, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Expertise Centre Pharmacotherapy in Old PersonsUtrechtThe Netherlands
| | - Patrick C. Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Marcel L. Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
| | - Wilma Knol
- Department of Geriatrics, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Expertise Centre Pharmacotherapy in Old PersonsUtrechtThe Netherlands
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Jordan S, Banner T, Gabe-Walters M, Mikhail JM, Panes G, Round J, Snelgrove S, Storey M, Hughes D. Nurse-led medicines' monitoring in care homes, implementing the Adverse Drug Reaction (ADRe) Profile improvement initiative for mental health medicines: An observational and interview study. PLoS One 2019; 14:e0220885. [PMID: 31509537 PMCID: PMC6738583 DOI: 10.1371/journal.pone.0220885] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/25/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Preventable adverse effects of medicines often pass unnoticed, but lead to real harm. Intervention Nurse-led monitoring using the structured Adverse Drug Reaction (ADRe) Profile identifies and addresses adverse effects of mental health medicines. Objectives This study investigated the implementation and clinical impact of ADRe, and barriers to and facilitators of sustained utilisation in routine practice. Methods Administration of ADRe was observed for 30 residents prescribed mental health medicines in ten care homes. The study pharmacist reviewed completed ADRes against medication records. Policy context was explored in 30 interviews with service users, nurse managers and strategic leads in Wales. Results Residents were aged 60–95, and prescribed 1–17 (median 9 [interquartile range (IQR) 7–13]) medicines. ADRe identified a median of 18 [IQR 11.5–23] problems per resident and nurses made 2 [1–2] changes to care per resident. For example: falls were reported for 9 residents, and care was modified for 5; pain was identified in 8 residents, and alleviated for 7; all 6 residents recognised as dyspnoeic were referred to prescribers. Nurses referred 17 of 30 residents to prescribers. Pharmacists recommended review for all 30. Doubts about administering ADRe, sometimes expressed by people who had not yet used it, diminished as it became familiar. ADRe was needed to bridge communication between resident, nurses and prescribers. When barriers of time, complacency, and doctors’ non-availability were overcome, reporting with ADRe made prescribers more likely to heed nurses’ concerns regarding residents’ welfare. Clinical gains were facilitated by one-to-one time, staff-resident relationships, and unification of documentation. Implications To our knowledge, ADRe is the only instrument that brings a full account of patients’ problems to medication reviews. This juxtaposition of signs and symptoms against prescriptions facilitates dose adjustments and de-prescribing and leads to: reduced pain and sedation; early identification of problems linked to ADRs, such as falls; and timely medication reviews e.g. for dyspnoea.
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Affiliation(s)
- Sue Jordan
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- * E-mail:
| | - Timothy Banner
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- Cardiff and Vale University Health Board, Wales, United Kingdom
| | | | - Jane M. Mikhail
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Gerwyn Panes
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Jeff Round
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Sherrill Snelgrove
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Mel Storey
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
- Hywel Dda University Health Board, Wales, United Kingdom
| | - David Hughes
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
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12
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Strandberg TE, Urtamo A, Kähärä J, Strandberg AY, Pitkälä KH, Kautiainen H. Statin Treatment Is Associated With a Neutral Effect on Health-Related Quality of Life Among Community-Dwelling Octogenarian Men: The Helsinki Businessmen Study. J Gerontol A Biol Sci Med Sci 2019; 73:1418-1423. [PMID: 29659717 DOI: 10.1093/gerona/gly073] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Indexed: 11/14/2022] Open
Abstract
Background Statin treatment is common among 80+ people, but little is known about statin effects on health-related quality of life (HRQoL) in this oldest age group. Methods In the Helsinki Businessmen Study (HBS), men born from 1919 to 1934 (original n = 3,490), have been followed-up since the 1960s. In 2015, a questionnaire about lifestyle, diseases, and medications, and including RAND-36/SF-36 HRQoL instrument was mailed to survivors. About 612 men (72.6%) responded, 530 of them reporting their medications (98% community-living). Propensity score analysis was used to compare statin users and nonusers for HRQoL. Results We compared 229 current statin users (median age 85 years, interquartile range 84-88 years) with 301 nonusers (86; 84-89 years). Current statin users had had significantly higher serum cholesterol level in midlife (p < .001), but current lifestyle-related characteristics were similar in users and nonusers. Statin users reported more hypertension (61.1%, p < .001), diabetes (23.6%, p <.001), and atherosclerotic cardiovascular disease (ASCVD, 33.6%, p <.001), than nonusers. Statin users reported higher mean scores than nonusers in all eight RAND-36 subscales, but after adjustments for multiplicity and a propensity score we found no significant differences between statin users and nonusers. Stratification for primary (no ASCVD) and secondary (with CVD) prevention supported the main results. Conclusions Our study suggests that statin treatment has no significant effect on health-related quality of life among octogenarian, community-dwelling men. The results contradict concerns about statin treatment in the oldest-old, and may caution against deprescribing of statins due to old age alone.
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Affiliation(s)
- Timo E Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Finland.,Center for Life Course Health Research, University of Oulu, Finland
| | - Annele Urtamo
- University of Helsinki, Clinicum, and Helsinki University Hospital, Finland
| | - Juuso Kähärä
- University of Helsinki, Clinicum, and Helsinki University Hospital, Finland
| | - Arto Y Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Finland
| | - Kaisu H Pitkälä
- University of Helsinki, Clinicum, and Helsinki University Hospital, Finland
| | - Hannu Kautiainen
- Kuopio University Hospital, Finland.,Folkhälsan Research Centre, Helsinki, Finland
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13
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Ofori-Asenso R, Ilomaki J, Tacey M, Curtis AJ, Zomer E, Bell JS, Zoungas S, Liew D. Prevalence and Incidence of Statin Use and 3-Year Adherence and Discontinuation Rates Among Older Adults With Dementia. Am J Alzheimers Dis Other Demen 2018; 33:527-534. [PMID: 29991271 PMCID: PMC10852509 DOI: 10.1177/1533317518787314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine the patterns of statin use and determine the 3-year adherence and discontinuation rates among a cohort of Australians aged ≥65 years with dementia. METHODS The yearly prevalence and incidence of statin use were compared via Poisson regression modeling using 2007 as the reference year. People with dementia were identified according to dispensing of antidementia medications. A cohort of 589 new statin users was followed longitudinally. Adherence was estimated via the proportion of days covered (PDC). Discontinuation was defined as ≥90 days without statin coverage. RESULTS The annual prevalence of statin use among older Australians with dementia increased from 20.6% in 2007 to 31.7% in 2016 (aged-sex adjusted rate ratio: 1.51, 95% confidence interval: 1.35-1.69). Among the new users, the proportion adherent (PDC ≥ 0.80) decreased from 60.3% at 6 months to 31.0% at 3 years. During the 3-year follow-up, 58.7% discontinued their statin. CONCLUSIONS Despite increased use of statins among older Australians with dementia, adherence is low and discontinuation is high, which may point to intentional cessation.
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Affiliation(s)
- Richard Ofori-Asenso
- Centre of cardiovascular Research and Education in therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jenni Ilomaki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Tacey
- Centre of cardiovascular Research and Education in therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrea J. Curtis
- Division of Metabolism, Ageing, and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ella Zomer
- Centre of cardiovascular Research and Education in therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Sophia Zoungas
- Division of Metabolism, Ageing, and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- Centre of cardiovascular Research and Education in therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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14
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Musich S, Wang SS, Schwebke K, Slindee L, Waters E, Yeh CS. Underutilization of Statin Therapy for Secondary Prevention of Cardiovascular Disease Among Older Adults. Popul Health Manag 2018; 22:74-82. [PMID: 29893617 PMCID: PMC6386076 DOI: 10.1089/pop.2018.0051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Secondary cardiovascular disease (CVD) clinical trials have demonstrated that higher intensity levels of statin therapy are more effective than lower levels in reducing mortality rates. Despite updated treatment guidelines, statin therapy may be underutilized, with evidence that females are treated less aggressively than males. The primary objective of this study was to determine the prevalence of statin utilization by varying therapy intensity by sex. The secondary objective was to document the benefits of statin therapy intensity levels on all-cause mortality for males and females. A 25% random sample of adults ≥65 years was utilized to identify those with established CVD. Inclusion criteria included: (1) 12-month pre period and (2) up to 30 months post period. Five categories of statin utilization were established: adherent to high-, moderate-, or low-intensity statin therapy, nonadherent, and no statins. Among eligible insureds (N = 49,530 males; N = 44,710 females), 20% of males and 12% of females were identified as high-intensity statin users. Mortality rates significantly increased similarly for males and females as statin therapy intensity decreased. Likewise, mortality hazard ratios indicated the most benefit from high-intensity statin therapy compared to all other categories. Statin therapy for secondary prevention of CVD is beneficial in reducing mortality for males and females but is underutilized, especially among females. Education programs among patients to increase heart health awareness and among physicians to promote the benefits of updated statin guidelines should be encouraged.
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Affiliation(s)
- Shirley Musich
- 1 Research for Aging Populations , Optum, Ann Arbor, Michigan
| | - Shaohung S Wang
- 1 Research for Aging Populations , Optum, Ann Arbor, Michigan
| | - Kay Schwebke
- 2 Informatics & Data Science , Optum, Ann Arbor, Michigan
| | - Luke Slindee
- 2 Informatics & Data Science , Optum, Ann Arbor, Michigan
| | - Evonne Waters
- 3 Medicare & Retirement, UnitedHealthcare Alliances , Minneapolis, Minnesota
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15
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Korhonen MJ, Ilomäki J, Sluggett JK, Brookhart MA, Visvanathan R, Cooper T, Robson L, Bell JS. Selective prescribing of statins and the risk of mortality, hospitalizations, and falls in aged care services. J Clin Lipidol 2018; 12:652-661. [PMID: 29574073 DOI: 10.1016/j.jacl.2018.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/26/2018] [Accepted: 02/20/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Compared to randomized controlled trials, nonexperimental studies often report larger survival benefits but higher rates of adverse events for statin use vs nonuse. OBJECTIVE We compared characteristics of statin users and nonusers living in aged care services and evaluated the relationships between statin use and all-cause mortality, all-cause and fall-related hospitalizations, and number of falls during a 12-month follow-up. METHODS A prospective cohort study of 383 residents aged ≥65 years was conducted in six Australian aged care services. Data were obtained from electronic medical records and medication charts and through a series of validated assessments. RESULTS The greatest differences between statin users and nonusers were observed in activities of daily living, frailty, and medication use (absolute standardized difference >0.40), with users being less dependent and less frail but using a higher number of medications. Statin use was associated with a decreased risk of all-cause mortality (adjusted hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.37-0.93) and hospitalizations (HR 0.67, 95% CI 0.46-0.98). After exclusion of residents unable to sit or stand, statin use was associated with a nonsignificant increase in the risk of fall-related hospitalizations (HR 1.47, 95% CI 0.80-2.68) but with a lower incidence of falls (incidence rate ratio 0.67, 95% CI 0.47-0.96). CONCLUSIONS The observed associations between statin use and the outcomes may be largely explained by selective prescribing and deprescribing of statins and variation in likelihood of hospitalization based on consideration of each resident's clinical and frailty status. Randomized deprescribing trials are needed to guide statin prescribing in this setting.
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Affiliation(s)
- Maarit J Korhonen
- NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; Institute of Biomedicine, University of Turku, Turku, Finland.
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - M Alan Brookhart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Renuka Visvanathan
- NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia; School of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Tina Cooper
- Resthaven Incorporated, Adelaide, South Australia, Australia
| | - Leonie Robson
- Resthaven Incorporated, Adelaide, South Australia, Australia
| | - J Simon Bell
- NHMRC Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Sansom Institute, University of South Australia, Adelaide, South Australia, Australia
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16
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Hamaker ME, Prins M, van Huis LH. Update in geriatrics: What geriatric oncology can learn from general geriatric research. J Geriatr Oncol 2018; 9:393-397. [PMID: 29396236 DOI: 10.1016/j.jgo.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 12/27/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
Abstract
Life expectancy has been steadily increasing for decades and this trend is likely to continue in coming years. In fact, there is more than a 50% probability that by 2030 female life expectancy could break the 90 year barrier, with more than half of the expected gains due to enhanced longevity above the age of 65 years. The resultant aging of societies means that health care will be faced with a rising number of increasingly older patients, who are also likely to have higher levels of multimorbidity. Most issues regarding assessment, prognostication and, management of older patients are not unique to geriatric oncology and thus there is opportunity to learn from progress in other fields. The purpose of this paper is to provide an update on research, reviews, and debate in general geriatrics that may be relevant to clinicians and researchers active in geriatric oncology. The selection of topics was based on a general search of the table of contents of widely read geriatrics and internal medicine journals, and includes geriatric co-management, improving research for older patients, caregiver issues, eliciting patient preferences, and shared-decision making.
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Affiliation(s)
- Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht/Zeist, The Netherlands.
| | - Meike Prins
- Department of Geriatric Medicine, Diakonessenhuis Utrecht/Zeist, The Netherlands
| | - Lieke H van Huis
- Department of Internal Medicine, Diakonessenhuis Utrecht/Zeist, The Netherlands
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17
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Schilling C, Petrie D, Dowsey MM, Choong PF, Clarke P. The Impact of Regression to the Mean on Economic Evaluation in Quasi-Experimental Pre-Post Studies: The Example of Total Knee Replacement Using Data from the Osteoarthritis Initiative. HEALTH ECONOMICS 2017; 26:e35-e51. [PMID: 28127856 DOI: 10.1002/hec.3475] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/23/2016] [Accepted: 12/02/2016] [Indexed: 06/06/2023]
Abstract
Many treatments are evaluated using quasi-experimental pre-post studies susceptible to regression to the mean (RTM). Ignoring RTM could bias the economic evaluation. We investigated this issue using the contemporary example of total knee replacement (TKR), a common treatment for end-stage osteoarthritis of the knee. Data (n = 4796) were obtained from the Osteoarthritis Initiative database, a longitudinal observational study of osteoarthritis. TKR patients (n = 184) were matched to non-TKR patients, using propensity score matching on the predicted hazard of TKR and exact matching on osteoarthritis severity and health-related quality of life (HrQoL). The economic evaluation using the matched control group was compared to the standard method of using the pre-surgery score as the control. Matched controls were identified for 56% of the primary TKRs. The matched control HrQoL trajectory showed evidence of RTM accounting for a third of the estimated QALY gains from surgery using the pre-surgery HrQoL as the control. Incorporating RTM into the economic evaluation significantly reduced the estimated cost effectiveness of TKR and increased the uncertainty. A generalized ICER bias correction factor was derived to account for RTM in cost-effectiveness analysis. RTM should be considered in economic evaluations based on quasi-experimental pre-post studies. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Chris Schilling
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Michelle M Dowsey
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Peter F Choong
- The University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Philip Clarke
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
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18
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Bertolotti M, Franchi C, Rocchi MBL, Miceli A, Libbra MV, Nobili A, Lancellotti G, Carulli L, Mussi C. Prevalence and Determinants of the Use of Lipid-Lowering Agents in a Population of Older Hospitalized Patients: the Findings from the REPOSI (REgistro POliterapie Società Italiana di Medicina Interna) Study. Drugs Aging 2017; 34:311-319. [PMID: 28299634 DOI: 10.1007/s40266-017-0448-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited. AIM The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients. METHODS We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della Società Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical profiles, including multimorbidity markers and polypharmacy. RESULTS 2171 patients aged >65 years were enrolled (1057 males, 1114 females, mean age 78.6 years). The patients treated with lipid-lowering drugs amounted to 508 subjects (23.4%), with no gender difference. Atorvastatin (39.3%) and simvastatin (34.0%) were the most widely used statin drugs. Likelihood of treatment was associated with polypharmacy (≥5 drugs) and with higher Cumulative Illness Rating Scale (CIRS) score. At logistic regression analysis, the presence of coronary heart disease, peripheral vascular disease, and hypertension were significantly correlated with lipid-lowering drug use, whereas age showed an inverse correlation. Diabetes was not associated with drug treatment. CONCLUSIONS In this in-hospital cohort, the use of lipid-lowering agents was mainly driven by patients' clinical history, most notably the presence of clinically overt manifestations of atherosclerosis. Increasing age seems to be associated with lower prescription rates. This might be indicative of cautious behavior towards a potentially toxic treatment regimen.
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Affiliation(s)
- Marco Bertolotti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy. .,Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Nuovo Ospedale Civile, via Giardini 1355, 41126, Modena, Italy.
| | - Carlotta Franchi
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Marco B L Rocchi
- Department of Biomolecular Sciences, University of Urbino, Urbino, Italy
| | - Andrea Miceli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Nuovo Ospedale Civile, via Giardini 1355, 41126, Modena, Italy
| | - M Vittoria Libbra
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Nuovo Ospedale Civile, via Giardini 1355, 41126, Modena, Italy
| | - Alessandro Nobili
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Giulia Lancellotti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Nuovo Ospedale Civile, via Giardini 1355, 41126, Modena, Italy
| | - Lucia Carulli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Nuovo Ospedale Civile, via Giardini 1355, 41126, Modena, Italy
| | - Chiara Mussi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Nuovo Ospedale Civile, via Giardini 1355, 41126, Modena, Italy
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