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Anche in soggetti ultra75enni in prevenzione primaria, l’interruzione della terapia con statine aumenta il rischio di eventi cardiovascolari
È stato condotto uno studio di coorte su oltre 120.000 pazienti, utilizzando le banche dati sanitarie nazionali francesi e includendo tutti i soggetti che avevano compiuto 75 anni, in prevenzione primaria e con un’aderenza al trattamento con statine ≥80% in ciascuno dei 2 anni precedenti.
Durante il follow-up, il 14,3% ha interrotto il trattamento con statine (tre mesi consecutivi senza esposizione alla terapia) e il 4,5% ha sperimentato un evento cardiovascolare. Gli HR per il rischio di qualsiasi evento cardiovascolare, evento coronarico, evento cerebrovascolare per i soggetti che interrompevano il trattamento erano del 33%, del 46% e del 26%, rispettivamente. Questo dato conferma il ruolo della terapia ipolipemizzante anche in questi soggetti, e sottolinea la necessità di una buona aderenza a essa. D’altra parte, sono necessari ulteriori studi, compresi trial randomizzati, per confermare questi risultati e supportare l'aggiornamento e il chiarimento delle linee guida sull'uso di statine negli anziani per la prevenzione primaria.
Cardiovascular effect of discontinuing statins for primary prevention at the age of 75 years: a nationwide population-based cohort study in France
Giral P, Neumann A, Weill A, Coste J.
Eur Heart J. 2019 [Epub30Jul]
AIMS: The role of statin therapy in primary prevention of cardiovascular disease in persons older than 75 years remains a subject of debate with little evidence to support or exclude the benefit of this treatment. We assessed the effect of statin discontinuation on cardiovascular outcomes in previously adherent 75-year-olds treated for primary prevention.
METHODS AND RESULTS: A population-based cohort study using French national healthcare databases was performed, studying all subjects who turned 75 in 2012-14, with no history of cardiovascular disease and with a statin medication possession ratio ≥80% in each of the previous 2 years. Statin discontinuation was defined as three consecutive months without exposure. The outcome was hospital admission for cardiovascular event. The hazard ratio comparing statin discontinuation with continuation was estimated using a marginal structural model adjusting for both baseline and time-varying covariates (cardiovascular drug use, comorbidities, and frailty indicators). A total of 120 173 subjects were followed for an average of 2.4 years, of whom 17 204 (14.3%) discontinued statins and 5396 (4.5%) were admitted for a cardiovascular event. The adjusted hazard ratios for statin discontinuation were 1.33 [95% confidence interval (CI) 1.18-1.50] (any cardiovascular event), 1.46 (95% CI 1.21-1.75) (coronary event), 1.26 (95% CI 1.05-1.51) (cerebrovascular event), and 1.02 (95% CI 0.74-1.40) (other vascular event).
CONCLUSION: Statin discontinuation was associated with a 33% increased risk of admission for cardiovascular event in 75-year-old primary prevention patients. Future studies, including randomized studies, are needed to confirm these findings and support updating and clarification of guidelines on the use of statins for primary prevention in the elderly.
