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



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.


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.


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.


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


1. Gurwitz JH, Go AS, Fortmann SP. Statins for Primary Prevention in Older Adults: Uncertainty and the Need for More Evidence. Jama. 2016;316(19):1971–2. doi: 10.1001/jama.2016.15212 27838724

2. Giral P, Neumann A, Weill A, Coste J. Cardiovascular effect of discontinuing statins for primary prevention at the age of 75 years: a nationwide population-based cohort study in France. European heart journal. 2019.

3. Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr., Kastelein JJ, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. The New England journal of medicine. 2008;359(21):2195–207. doi: 10.1056/NEJMoa0807646 18997196

4. Yusuf S, Bosch J, Dagenais G, Zhu J, Xavier D, Liu L, et al. Cholesterol Lowering in Intermediate-Risk Persons without Cardiovascular Disease. The New England journal of medicine. 2016;374(21):2021–31. doi: 10.1056/NEJMoa1600176 27040132

5. Ridker PM, Lonn E, Paynter NP, Glynn R, Yusuf S. Primary Prevention With Statin Therapy in the Elderly: New Meta-Analyses From the Contemporary JUPITER and HOPE-3 Randomized Trials. Circulation. 2017;135(20):1979–81. doi: 10.1161/CIRCULATIONAHA.117.028271 28385949

6. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. Circulation. 2018:Cir0000000000000625.

7. NIH Collaboratory Distributed Research Network. National Institutes of Health. Accessed 22 February 2019.

8. Sentinel System. Common data model version 6.0. Available at: Accessed 22 February 2019.

9. Mini-Sentinel (Raebel MA, Schroeder EB, Goodrich G, Paolino AR, Donahoo WT, Fuller C, et al). Validating Type 1 and Type 2 Diabetes Mellitus in the Mini-Sentinel Distributed Database Using the Surveillance, Prevention, and Management of Diabetes Mellitus (SUPREME-DM) Datalink. 2016. Available at:

10. Toh S, Reichman ME, Graham DJ, Hampp C, Zhang R, Butler MG, et al. Prospective Postmarketing Surveillance of Acute Myocardial Infarction in New Users of Saxagliptin: A Population-Based Study. Diabetes care. 2018;41(1):39–48. doi: 10.2337/dc17-0476 29122893

11. Presley CA, Min JY, Chipman J, Greevy RA, Grijalva CG, Griffin MR, et al. Validation of an algorithm to identify heart failure hospitalisations in patients with diabetes within the veterans health administration. BMJ Open. 2018;8(3):e020455. doi: 10.1136/bmjopen-2017-020455 29581206

12. Andrade SE, Harrold LR, Tjia J, Cutrona SL, Saczynski JS, Dodd KS, et al. A systematic review of validated methods for identifying cerebrovascular accident or transient ischemic attack using administrative data. Pharmacoepidemiol Drug Saf. 2012;21 Suppl 1:100–28.

13. Mini-Sentinel (Go AS, Singer D, Cheetham C, Toh D, Reichman M, Graham D, et al). A protocol for assessment of dabigatran, version 3. 2015. Availale at:

14. Panozzo CA, Woodworth TS, Welch EC, Huang TY, Her QL, Haynes K, et al. Early impact of the ICD-10-CM transition on selected health outcomes in 13 electronic health care databases in the United States. Pharmacoepidemiol Drug Saf. 2018;27(8):839–47. doi: 10.1002/pds.4563 29947033

15. Centers for Medicare and Medicaid Services. 2018 ICD-10-CM and GEMs. 2018. Available at: Accessed 22 February 2019.

16. Sentinel System. Routine querying system documentation. Available at: Accessed 22 February 2019.

17. Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G, et al. Statins for the primary prevention of cardiovascular disease. The Cochrane database of systematic reviews. 2013(1):Cd004816. doi: 10.1002/14651858.CD004816.pub5 23440795

18. Johansen ME, Green LA. Statin Use in Very Elderly Individuals, 1999–2012. JAMA Intern Med. 2015;175(10):1715–6. doi: 10.1001/jamainternmed.2015.4302 26301475

19. Ziaeian B, Dinkler J, Guo Y, Watson K. The 2013 ACC/AHA Cholesterol Treatment Guidelines: Applicability to Patients with Diabetes. Curr Diab Rep. 2016;16(2):13. doi: 10.1007/s11892-015-0703-5 26803649

20. Casula M, Mozzanica F, Scotti L, Tragni E, Pirillo A, Corrao G, et al. Statin use and risk of new-onset diabetes: A meta-analysis of observational studies. Nutrition, metabolism, and cardiovascular diseases: NMCD. 2017;27(5):396–406. doi: 10.1016/j.numecd.2017.03.001 28416099

21. Thakker D, Nair S, Pagada A, Jamdade V, Malik A. Statin use and the risk of developing diabetes: a network meta-analysis. Pharmacoepidemiol Drug Saf. 2016;25(10):1131–49. doi: 10.1002/pds.4020 27277934

22. Weinberger Y, Han BH. Statin treatment for older adults: the impact of the 2013 ACC/AHA cholesterol guidelines. Drugs Aging. 2015;32(2):87–93. doi: 10.1007/s40266-014-0238-5 25586520

23. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S1–45.

24. O'Keeffe AG, Petersen I, Nazareth I. Initiation rates of statin therapy for the primary prevention of cardiovascular disease: an assessment of differences between countries of the UK and between regions within England. BMJ Open. 2015;5(3):e007207. doi: 10.1136/bmjopen-2014-007207 25748418

25. Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. Jama. 2002;288(4):462–7. doi: 10.1001/jama.288.4.462 12132976

26. Ofori-Asenso R, Jakhu A, Zomer E, Curtis AJ, Korhonen MJ, Nelson M, et al. Adherence and Persistence Among Statin Users Aged 65 Years and Over: A Systematic Review and Meta-analysis. The journals of gerontology Series A, Biological sciences and medical sciences. 2018;73(6):813–9. doi: 10.1093/gerona/glx169 28958039

27. Slejko JF, Ho M, Anderson HD, Nair KV, Sullivan PW, Campbell JD. Adherence to statins in primary prevention: yearly adherence changes and outcomes. Journal of managed care pharmacy: JMCP. 2014;20(1):51–7. doi: 10.18553/jmcp.2014.20.1.51 24372460

28. Korhonen MJ, Ruokoniemi P, Ilomaki J, Meretoja A, Helin-Salmivaara A, Huupponen R. Adherence to statin therapy and the incidence of ischemic stroke in patients with diabetes. Pharmacoepidemiol Drug Saf. 2016;25(2):161–9. doi: 10.1002/pds.3936 26687512

29. Zhang H, Plutzky J, Skentzos S, Morrison F, Mar P, Shubina M, et al. Discontinuation of statins in routine care settings: a cohort study. Ann Intern Med. 2013;158(7):526–34. doi: 10.7326/0003-4819-158-7-201304020-00004 23546564

30. Ofori-Asenso R, Ilomaki J, Tacey M, Si S, Curtis AJ, Zomer E, et al. Predictors of first-year nonadherence and discontinuation of statins among older adults: a retrospective cohort study. British journal of clinical pharmacology. 2019;85(1):227–35. doi: 10.1111/bcp.13797 30402916

31. National Health and Nutrition Examination Survey. Available at: Accessed 9 April 2019.

32. Henry J. Kaiser Family Foundation. An overview of Medicare. 2019. Accessed 9 August 2019.

33. Miller EA, Decker SL, Parker JD. Characteristics of Medicare Advantage and Fee-for-Service Beneficiaries Upon Enrollment in Medicare at Age 65. The Journal of ambulatory care management. 2016;39(3):231–41. doi: 10.1097/JAC.0000000000000107 27232684

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