Association of statin use in older people primary prevention group with risk of cardiovascular events and mortality: a systematic review and meta-analysis of observational studies

Awad, Kamal; Mohammed, Maged; Zaki, Mahmoud Mohamed; Abushouk, Abdelrahman I.; Lip, Gregory Y. H.; Blaha, Michael J.; Lavie, Carl J.; Toth, Peter P.; Jukema, J. Wouter; Sattar, Naveed; Banach, Maciej

doi:10.1186/s12916-021-02009-1

Table 1 Characteristics and baseline parameters of the included studies

From: Association of statin use in older people primary prevention group with risk of cardiovascular events and mortality: a systematic review and meta-analysis of observational studies

Study	Year			Country			Design			Follow-up (years)		Population
Alpérovitch et al. [25]	2015			France			Prospective cohort			9.1^a		Older people ≥ 65 years without a history of CVD
Bezin et al. [26]	2019			France			Retrospective cohort			4.7^b		People ≥ 75 years with and without a history of CVD
Gitsels et al. [27]	2016			UK			Retrospective cohort			16–24		People aged 60, 65, 70, and 75 years without a history of CVD stratified according to the QRISK2 score
Jun et al. [32]	2019			South Korea			Nested case-control			NA		People who developed first time CV event or death ≥ 75 years and their matched controls
Kim et al. [28]	2019			South Korea			Retrospective cohort			5.2^b		Patients > 75 years with at least one CV risk factor (HTN, DM, or overweight) and without a history of CVD
Lemaitre al [31].	2002			USA			Prospective cohort			Up to 7.3		Older people ≥ 65 years without a history of CVD
Orkaby et al. [29]	2017			USA			Prospective cohort			7^b		Male physicians ≥ 70 years without a history of CVD
Orkaby et al. [33]	2020			USA			Retrospective cohort			6.8^a		US veterans ≥ 75 years without history of CVD
Ramos et al. [30]	2018			Spain			Retrospective cohort			5.6^b		Older people ≥ 75 years without a history of CVD
Zhou et al. [34]	2020			Australia, USA			Retrospective cohort			4.7^b		Older people from ASPREE trial ≥ 70 years without a history of CVD, dementia, and physical disability
Study	Groups of interest		Age, (years)	Women	BMI	LDL-C	HDL-C	TG	Family history of CVD	Smoker		Alcoholic		DM	HTN	Renal disease
Study	Groups of interest		Age, (years)	Women	BMI	LDL-C	HDL-C	TG	Family history of CVD	EX	Current	Ex	Current	DM	HTN	Renal disease
Alpérovitch et al. [25]	Statin prevalent users (n = 1007)		73.1 (4.6)	67.8	25.8 (4.0)	3.40 (0.9)	1.64 (0.4)	1.27 (0.84–1.93)^c	NR	30.2	4.4	1.1	81.8	10.9	79.7	NR
Alpérovitch et al. [25]	No LLT (n = 5436)		74.1 (5.6)	62	25.4 (4.0)	3.78 (0.9)	1.63 (0.4)	1.14 (0.76–1.70)^c	NR	31.3	6.3	2.8	79.7	7.2	74.5	NR
Bezin et al. [26]	Primary prevention without modifiable risk factors (n = 752)		78 (76–81)^c	71.8	NR	NR	NR	NR	NR	NR	NR	NR	NR	0	0^d	NR
Gitsels et al. [27]	QRISK2 < 10%	Statin prevalent users (n = 883)	65	100	26 (4)	NR	NR	NR	0	10	0	NR	NR	0	5	0
		No LLT (n = 39,866)	65	100	26 (4)	NR	NR	NR	0	10	3	NR	NR	0	1	0
		Statin prevalent users (n = 3)	70	100	28 (6)	NR	NR	NR	0	0	0	NR	NR	0	0	0
		No LLT (n = 322)	70	100	25 (4)	NR	NR	NR	0	4	3	NR	NR	0	0	0
	QRISK2 = 10–19%	Statin prevalent users (n = 6438)	65	68	28 (5)	NR	NR	NR	1	24	10	NR	NR	7	56	0
		No LLT (n = 116,240)	65	47	26 (4)	NR	NR	NR	0	21	20	NR	NR	1	24	0
		Statin prevalent users (n = 10,822)	70	92	27 (5)	NR	NR	NR	1	20	1	NR	NR	0	55	2
		No LLT (n = 108,703)	70	86	26 (5)	NR	NR	NR	0	17	5	NR	NR	0	21	0
		Statin prevalent users (n = 661)	75	100	26 (4)	NR	NR	NR	0	5	0	NR	NR	0	2	0
		No LLT (n = 13,685)	75	100	25 (4)	NR	NR	NR	0	5	1	NR	NR	0	0	0
	QRISK2 ≥ 20%	Statin prevalent users (n = 5259)	65	33	29 (5)	NR	NR	NR	1	32	32	NR	NR	59	77	0
		No LLT (n = 29,170)	65	16	27 (5)	NR	NR	NR	1	19	57	NR	NR	22	49	0
		Statin prevalent users (n = 25,559)	70	37	29 (5)	NR	NR	NR	2	38	18	NR	NR	39	73	12
		No LLT (n = 98,900)	70	24	26 (4)	NR	NR	NR	1	28	31	NR	NR	8	37	2
		Statin prevalent users (n = 34,743)	75	56	28 (5)	NR	NR	NR	1	34	10	NR	NR	29	74	15
		No LLT (n = 142,521)	75	55	26 (4)	NR	NR	NR	0	25	16	NR	NR	5	39	2
Jun et al. [32]	Cases (n = 11,017)		83.7 (3.2)	63.2	NR	NR	NR	NR	NR	NR	NR	NR	NR	14.7	44.2	NR
Jun et al. [32]	Controls (n = 55,085)		83.7 (3.2)	63.2	NR	NR	NR	NR	NR	NR	NR	NR	NR	11.5	49.9	NR
Kim et al. [28]	Statin new users (n = 639)		78 (76–80)^c	64.6	23.4 (22.2–25.8)^c	107 (85–133)^c	45 (39–54)^c	110 (82–150)^c	NR	NR	NR	NR	NR	32.6	95.6	3.1
Kim et al. [28]	No statin (n = 639)		78 (76-80)^c	61.3	23.3 (22–25.6)^c	107 (85–129)^c	46 (38–55)^c	107 (79–151)^c	NR	NR	NR	NR	NR	30.8	95.9	3.1
Lemaitre al [31].	Treated prevalent users (n = 251)		71.1 (4.6)	68.5	26.9 (4.4)	142.7 (42.2)	53.6 (15.8)	154.2 (87.1)	35.3	NR	9.6	NR	49.4	21.9	48.2	NR
	Untreated	Drug Recommended (n = 717)	72.7 (5.6)	66.7	27.4 (4.5)	177.2 (28.8)	50.9 (12.1)	153.1 (56.5)	42.5	NR	14.6	NR	45.3	20.5	48.1	NR
	Untreated	Diet Recommended (n = 946)	72.5 (5.3)	63.4	27.2 (5)	147.5 (21)	53.0 (13.7)	141.4 (57)	36.4	NR	13.9	NR	48.9	20	43.7	NR
Orkaby et al. [29]	Statin prevalent users (n = 1130)		76 (4.5)	0	25.6 (3.1)	NR	NR	NR	NR	48.9	2.9	NR	NR	13	73.8	10.8
Orkaby et al. [29]	No statin (n = 1130)		76 (4.6)	0	25.6 (3.2)	NR	NR	NR	NR	50.5	3.3	NR	NR	13.1	75.3	10.6
Orkaby et al. [33]	Statin new users (n = 57,178)		81.2 (3.6)	2.7	27.5 (4.3)	NR	NR	NR	NR	63.5	7.4	NR	NR	27	80.4	2.3
Orkaby et al. [33]	No statin (n = 326,981)		80.7 (4.0)	2.7	26.7 (4.4)	NR	NR	NR	NR	71.9	7.3	NR	NR	13.1	66.2	1.1
Ramos et al. [30]	No T2DM, 75–84 years.	Statin new users (n = 4802)	78.8 (2.7)	65.1	28.6 (4.6)	3.9 (1.0)	1.5 (0.4)	1.4 (0.7)	NR	NR	13.5	NR	NR	0	65.7	NR
	No T2DM, 75–84 years.	No statin (n = 27,114)	79.1 (2.8)	62.8	28.4 (4.6)	3.3 (0.7)	1.5 (0.4)	1.2 (0.5)	NR	NR	12.4	NR	NR	0	57.3	NR
	No T2DM, ≥ 85 years.	Statin new users (n = 743)	88.5 (3.2)	69.8	27.1 (4.3)	3.7 (1.0)	1.5 (0.4)	1.4 (0.6)	NR	NR	7.8	NR	NR	0	66.8	NR
	No T2DM, ≥ 85 years.	No statin (n = 6325)	88.6 (3.2)	69.8	27.6 (4.5)	3.1 (0.8)	1.6 (0.4)	1.2 (0.5)	NR	NR	6.7	NR	NR	0	58.7	NR
	T2DM, 75–84 years	Statin new users (n = 1756)	78.8 (2.6)	61.3	29.7 (4.7)	3.7 (0.9)	1.4 (0.4)	1.7 (0.8)	NR	NR	15.4	NR	NR	100	78.4	NR
	T2DM, 75–84 years	No statin (n = 4885)	79.2 (2.8)	58	29.4 (4.8)	3 (0.7)	1.4 (0.4)	1.4 (0.7)	NR	NR	14.7	NR	NR	100	75.1	NR
	T2DM, ≥ 85 years	Statin new users (n = 201)	88.2 (2.8)	67.2	28.2 (4.3)	3.3 (1.0)	1.4 (0.3)	1.6 (0.9)	NR	NR	6.5	NR	NR	100	82.6	NR
	T2DM, ≥ 85 years	No statin (n = 1038)	88.2 (2.7)	68	27.5 (4.4)	3 (0.7)	1.4 (0.4)	1.4 (0.7)	NR	NR	8.2	NR	NR	100	75.8	NR
Zhou et al. [34]	Statin prevalent users (n = 5629)		74.2 (71.8–77.7)^c	60.6	NR	NR	NR	NR	65.1	41.6	3.8	NR	75.6	19.6	82.4	29.9
Zhou et al. [34]	No statin (n = 12,467)		74.2 (71.8–77.9)^c	54.0	NR	NR	NR	NR	59.3	40.6	3.4	NR	78.3	6.1	70.8	24.0

Continuous data are presented as mean (standard deviation)
Dichotomous data are presented as percentage
Abbreviations: CVD cardiovascular disease, HTN hypertension, DM diabetes mellitus, BMI body mass index, LDL-C low-density lipoprotein cholesterol, HDL-C high-density lipoprotein cholesterol, TG triglycerides, LLT lipid-lowering treatment, NR not reported, ASPREE Aspirin in Reducing Events in the Elderly
^aData are presented as mean
^bData are presented as median
^cData are presented as median (interquartile range)
^dParticipants on antihypertensive drugs

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