• Ashish Sarraju, Gabriela Spencer-Bonilla, Sukyung Chung, Sofia Gomez, Jiang Li, Paul Heidenreich, Latha Palaniappan, and Fatima Rodriguez.
• Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, 870 Quarry Road, Falk CVRC, Stanford, CA, 94305-5406, USA. asarraju@stanford.edu.
• J Gen Intern Med. 2022 Aug 1; 37 (11): 264226492642-2649.

BackgroundThere remains uncertainty regarding optimal primary atherosclerotic cardiovascular disease (ASCVD) prevention practices for older adults.ObjectiveTo assess statin treatment patterns and incident ASCVD among older patients for primary prevention across the spectrum of ASCVD risk.DesignRetrospective cohort study of participants without ASCVD aged 65-79 years. Patients were stratified by age (65-69, 70-75, > 75 years) and 10-year ASCVD risk category (low/borderline, intermediate, high) based on the Pooled Cohort Equations. Multivariable logistic regressions were used to identify predictors of moderate- or high-intensity statin prescriptions. Cox proportional models were used to estimate hazard ratios (HRs) for incident ASCVD.ParticipantsPatients aged 65-79 years without ASCVD from a Northern California health system.Main MeasuresStatin prescriptions and incident ASCVD events.Key ResultsThere were 54,066 patients, with 10,288 (19%) aged > 75 years and 57% women. Compared with younger groups, adults > 75 years were less likely to be prescribed moderate- or high-intensity statin prescriptions across ASCVD risk groups (all p < 0.001); this persisted after multivariable adjustment including for ASCVD risk (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.74-0.86). Adults > 75 years were more likely to experience incident ASCVD (HR 1.42, 95% CI 1.23-1.63). Women (OR 0.85, 95% CI 0.81-0.89) and underweight older adults (OR 0.45, 95% CI 0.33-0.61) were also less likely to receive moderate- or high-intensity statins.ConclusionsAmong older adults aged 65-79 years without prior ASCVD, those > 75 years of age were less likely to receive moderate- or high-intensity statins regardless of ASCVD risk compared with their younger counterparts, while experiencing more incident ASCVD. Efforts are warranted to study the reasons for age-based differences in statin use in older adults, particularly those at highest ASCVD risk.© 2021. Society of General Internal Medicine.

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