Statin use and clinical outcomes in older men: a prospective population-based study
- Danijela Gnjidic1,2,3,4,
- David G Le Couteur2,4,5,
- Fiona M Blyth2,4,
- Tom Travison6,
- Kris Rogers7,
- Vasi Naganathan2,4,
- Robert G Cumming2,4,8,
- Louise Waite2,4,
- Markus J Seibel4,5,
- David J Handelsman4,5,
- Andrew J McLachlan1,2,
- Sarah N Hilmer3,4
- 1Faculty of Pharmacy, University of Sydney, Sydney, Australia
- 2Centre for Education and Research on Ageing, University of Sydney and Concord RG Hospital, Sydney, New South Wales, Australia
- 3Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia.
- 4Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- 5ANZAC Institute, Concord Hospital, Sydney, New South Wales, Australia
- 6Departments of Medicine and Biostatistics, Boston University, Boston, Massachusetts, USA
- 7Department of Intramural Research, The Sax Institute, Sydney, New South Wales, Australia
- 8Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Correspondence to Dr Danijela Gnjidic;
- Received 12 November 2012
- Revised 29 January 2013
- Accepted 31 January 2013
- Published 9 March 2013
Objective The aim of this analysis was to investigate the relationship of statins with institutionalisation and death in older men living in the community, accounting for frailty.
Design Prospective cohort study.
Setting Community-dwelling men participating in the Concord Health and Ageing in Men Project, Sydney, Australia.
Participants Men aged ≥70 years (n=1665).
Measurements Data collected during baseline assessments and follow-up (maximum of 6.79 years) were obtained. Information regarding statin use was captured at baseline, between 2005 and 2007. Proportional hazards regression analysis was conducted to estimate the risk of institutionalisation and death according to statin use (exposure, duration and dose) and frailty status, with adjustment for sociodemographics, medical diagnosis and other clinically relevant factors. A secondary analysis used propensity score matching to replicate covariate adjustment in regression models.
Results At baseline, 43% of participants reported taking statins. Over 6.79 years of follow-up, 132 (7.9%) participants were institutionalised and 358 (21.5%) participants had died. In the adjusted models, baseline statin use was not statistically associated with increased risk of institutionalisation (HR=1.60; 95% CI 0.98 to 2.63) or death (HR=0.88; 95% CI 0.66 to 1.18). There was no significant association between duration and dose of statins used with either outcome. Propensity scoring yielded similar findings. Compared with non-frail participants not prescribed statins, the adjusted HR for institutionalisation for non-frail participants prescribed statins was 1.43 (95% CI 0.81 to 2.51); for frail participants not prescribed statins, it was 2.07 (95% CI 1.11 to 3.86) and for frail participants prescribed statins, it was 4.34 (95% CI 2.02 to 9.33).
Conclusions These data suggest a lack of significant association between statin use and institutionalisation or death in older men. These findings call for real-world trials specifically designed for frail older people to examine the impact of statins on clinical outcomes.
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