Incidence of statin use in older adults with and without cardiovascular disease and diabetes mellitus, January 2008- March 2018


Autoři: Catherine A. Panozzo aff001;  Lesley H. Curtis aff002;  James Marshall aff001;  Lawrence Fine aff003;  Barbara L. Wells aff003;  Jeffrey S. Brown aff001;  Kevin Haynes aff004;  Pamala A. Pawloski aff005;  Adrian F. Hernandez aff002;  Sarah Malek aff001;  Beth Syat aff001;  Richard Platt aff001
Působiště autorů: Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, United States of America aff001;  Department of Population Health Sciences, Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC, United States of America aff002;  Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States of America aff003;  HealthCore, Inc., Wilmington, DE, United States of America aff004;  HealthPartners Institute, Minneapolis, MD, United States of America aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0223515

Souhrn

Background

Data from randomized controlled trials and observational studies on older adults who take statins for primary prevention of atherosclerotic cardiovascular disease are limited. To determine the incidence of statin use in older adults with and without cardiovascular disease (CVD) and/or diabetes (DM), we conducted a descriptive observational study.

Methods

The cohort consisted of health plan members in the NIH Collaboratory Distributed Research Network aged >75 years who had continuous drug and medical benefits for ≥183 days during the study period, January 1, 2008- March 31, 2018. We defined DM and CVD using diagnosis codes, and identified statins using dispensing data. Statin use was considered incident if a member had no evidence of statin exposure in the claims during the previous 183 days, and the use was considered long-term if statins were supplied for ≥180 days. Incidence rates were reported among members with and without CVD and/or diabetes, and stratified by year, sex, and age group.

Results

Among 757,569 eligible members, 109,306 older adults initiated statins and 54,624 became long-term users. Health plan members with CVD had the highest incidence of statin use (143.9 initiators per 1,000 member-years for CVD & DM; 114.5 initiators per 1,000 member-years for CVD & No DM). Among health plan members without CVD, those with DM had rates of statin use that were over two times higher than members without DM (76.1 versus 34.5 initiators per 1,000 member-years, respectively). Statin initiation remained steady throughout 2008–2016, was slightly higher in males, and declined with increasing age.

Conclusion

Incidence of statin use varied by CVD and DM comorbidity, and was lowest among those without CVD. These results highlight the potential clinical equipoise to conduct large pragmatic clinical trials to generate evidence that could be used to inform future blood cholesterol guidelines.

Klíčová slova:

Age groups – Blood – Cardiovascular diseases – Elderly – Medicare – Network analysis – Statins


Zdroje

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2019 Číslo 12