The JAMA published a study online which examines the Effect of Statin Treatment vs Usual Care on Primary CV Prevention Among Older Adults. The full paper is below as a pdf file. I’ve written about the overuse of this type of cholesterol lowering drugs in the primary prevention of cardiovascular disease several times. Primary prevention is the prevention of a disease which has yet to manifest itself in a patient. This form of cholesterol lowering drug therapy is very controversial as it likely doesn’t work and some have even suggested that it may be harmful. It certainly is costly and has side effects. Secondary prevention attempts to avoid a recurrence of a disease that a patient has already suffered. This treatment with statins is much less controversial.
The JAMA paper below concludes that statin therapy, pravastatin in this case, has no beneficial effect when used for primary prevention of CVD in patients 65 and older and might have been harmful in those above 75. This latter suggestion is tenuous as the tendency towards harm was not statistically significant.
An editorial accompanied this paper. It too is below as a pdf file. It emphasizes that “[s]tatin therapy may be associated with a variety of musculoskeletal disorders,including myopathy,myalgias, muscle weakness, back conditions, injuries, and arthropathies. These disorders may be particularly problematic in older people and may contribute to physical deconditioning and frailty. Statins have also been associated with cognitive dysfunction, which may further contribute to reduced functional status, risk of falls, and disability.”
I think the evidence against the use of statin therapy for the primary prevention of CVD in the elderly is very persuasive. I would not use statins in this situation. As I mentioned at the top of this piece it’s still not certain if statins have any role in primary prevention in any age group.
The second study I wish to briefly comment on also appeared in the JAMA. Association Between Teaching Status and Mortality in US Hospitals by Burke, et al from Boston. The objective of the study was to “examine risk-adjusted outcomes for patients admitted to teaching vs nonteaching hospitals across a broad range of medical and surgical conditions.”
“The sample [studied] consisted of 21 451 824 total hospitalizations at 4483 hospitals, of which 250 (5.6%) were major teaching, 894 (19.9%) were minor teaching, and 3339 (74.3%) were nonteaching hospitals. Unadjusted 30-day mortality was 8.1% at major teaching hospitals, 9.2% at minor teaching hospitals, and 9.6% at nonteaching hospitals, with a 1.5% (95% CI, 1.3%-1.7%; P < .001) mortality difference between major teaching hospitals and nonteaching hospitals.” These differences persisted even after the data were adjusted for differing characteristics among the various classes of hospitals studied. Costs tend to be higher at teaching hospitals. Thus, the obvious question is the decrease in mortality worth the expenditure?
These differences are small, but significant. The authors offer no explanation for their findings and neither can I; but the differences are interesting and deserve further examination.