Among patients aged 80 or older, high adherence to statins after a myocardial infarction appears to be associated with improved survival. Promoting medication adherence interventions to individuals in this age range may extend survival.
Use of statins to reduce cardiovascular disease (CVD) risks requires careful consideration when managing patients aged 80 years and older. Clinicians must weigh the potential benets of cardiovascular protection with statins against possible adverse effects and drug-drug interactions. These decisions can be complex because patients in this age range are particularly vulnerable due to a variety of reasons. Further complicating matters is that patients aged 80 and older are an under-represented group in large randomized trials. This has led to a lack of data on the benets of statins in this age group.
Adherence presents a considerable challenge in older patients because many of them are prescribed multiple medications, explainsMingsum Lee, MD, PhD.Declining cognitive function, lack of social support, and concerns for adverse effects also contribute to poor adherence.These are important issues when caring for survivors of myocardial infarction because statins are a mainstay of treatment.
For a study published in the Journal of the American Geriatrics Society, Dr. Lee and colleagues sought to describe patterns of statin adherence in patients aged 80 and older using a large multicenter cohort of diverse adults. In addition to describing these patterns, we wanted to identify factors associated with suboptimal adherence to statins and determine the potential impact of suboptimal statin adherence on mortality, Dr. Lee says.
For the retrospective population-based study, the authors looked at more than 5,600 patients aged 80 and older who were hospitalized with a principal diagnosis of acute myocardial infarction over a 10-year period (2006-2018). Statin adherence was based on proportion of days covered (PDC), and adherence levels were categorized as high (PDC 80% or higher), partial (PDC 40% or higher andlower than80%), and low (PDC lower than 40%).
Results of the study showed that nearly 70% of patients aged 80 or older were highly adherent to statin therapy and about 20% were partially adherent. Importantly, we observed gender and racial disparities in statin adherence, says Dr. Lee (Table).Women and patients from minority racial and ethnic groups were less likely to be adherent to statin therapy. In addition, the study showed that hyperlipidemia increased the odds of high statin adherence by 17%, whereas heart failure decreased the odds of high statin adherence by 15%.
Regarding mortality, the greatest survival rates were observed among patients with the highest statin adherence. Both low and partial adherence were associated with increased mortality. These trends remained even after adjusting for demographics, comorbidities, and exposure to other cardiac medications. Overall, poor adherence to statin therapy was associated with signicantly worse long-term survival, says Dr. Lee.
As life expectancy continuing to rise in the United States, people aged 80 or older have become one of the fastest-growing subpopulations in the country. Cardiovascular risk factors are common in this age group, and they carry a disproportionate burden of CVD. National guidelines note that it is reasonable to consider using statins in patients aged 75 and older to reduce CVD risks after careful consideration of risk-reduction benets, potential adverse effects and drug-drug interactions, and patient preferences.
The study by Dr. Lee and colleagues supports considering statins and promoting medication adherence, even in patients aged 80 or older. Gender and racial disparities in statin adherence remain true for patients in this age range, Dr. Lee says.Nonadherence may be an important contributor to disparities in cardiovascular outcomes based on race, ethnicity, and gender.
To enhance patient outcomes, Dr. Lee recommends efforts be made to educate patients aged 80 and older on the risks and benefits of statins. In addition, it is important to provided medication reminders, improve coordination of care, simplify dosing regimens, and discuss costs of statins whenever possible, she says. These efforts have been promising in younger patient populations and may be beneficial when managing adults aged 80 and older. Implementation of interventions to improve adherence may improve cardiovascular mortality in this population.
Phan DQ, Lam B, Hekimian A, Wee D, Zadegan R, Lee MS. Statin adherence and mortality in patients aged 80 years and older after acute myocardial infarction. J Am Geriatr Soc. 2019 Jun 17 [Epub ahead of print]. Available at: https://onlinelibrary.wiley.com/doi/pdf/10.1111/jgs.16037 and at: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.16037?referrer_access_token=LnEw90V1Gkh6fsfBz2hMOYta6bR2k8jH0KrdpFOxC66ON8Xx8AKwfxUaIejDRmGhMC4lbudMxUzWMxjATrbH-9PfVCZbzWzRYiOMdYY4y2_vf82omIh_7o21eXuGKSIet7h8R3n7VDndqxUJy9fg%3D%3D.
Leya M, Stone NJ. Statin prescribing in the elderly: special considerations. Curr Atheroscler Rep. 2017;19:47.
Ko DT, Mamdani M, Alter DA. Lipid-lowering therapy with statins in high-risk elderly patients: the treatment-risk paradox. JAMA. 2004;291:1864-1870.
Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2889-2934.
See original here:
Statin Adherence and Mortality in Octogenarians - Physician's Weekly
- ST-Segment Elevation Myocardial Infarction - verywell.com - May 12th, 2018 [May 12th, 2018]
- Myocardial infarction (Heart Attack) - Health Facts - June 21st, 2018 [June 21st, 2018]
- Heart Attack and Acute Coronary Syndrome - Lab Tests Online - June 21st, 2018 [June 21st, 2018]
- Myocardial Infarction - ECGpedia - September 21st, 2018 [September 21st, 2018]
- Myocardial Infarction Clinical Presentation: History ... - September 25th, 2018 [September 25th, 2018]
- Myocardial infarction diagnosis - Wikipedia - September 25th, 2018 [September 25th, 2018]
- Myocardial Infarction Treatment & Management: Approach ... - October 9th, 2018 [October 9th, 2018]
- Myocardial infarction - Simple English Wikipedia, the free ... - October 18th, 2018 [October 18th, 2018]
- ST-Segment Elevation Myocardial Infarction - October 18th, 2018 [October 18th, 2018]
- ECG localization of myocardial infarction / ischemia and ... - October 18th, 2018 [October 18th, 2018]
- Heart Attack (Myocardial Infarction) Symptoms | Cleveland Clinic - November 15th, 2018 [November 15th, 2018]
- Myocardial Infarction (Heart Attack) Ischemia Pathophysiology, ECG, Nursing, Signs, Symptoms Part 1 - November 15th, 2018 [November 15th, 2018]
- Myocardial Infarction (MI) NCLEX Questions - November 30th, 2018 [November 30th, 2018]
- Myocardial Infarction NCLEX Review (Part 1) - December 3rd, 2018 [December 3rd, 2018]
- Acute Myocardial Infarction, Myocardial infection. Patient - December 4th, 2018 [December 4th, 2018]
- Heart Attack | Myocardial Infarction | MedlinePlus - December 16th, 2018 [December 16th, 2018]
- Heart Attack (Myocardial Infarction) - medicinenet.com - December 17th, 2018 [December 17th, 2018]
- Myocardial infarction (acute): Early rule out using high ... - December 20th, 2018 [December 20th, 2018]
- Conditions We Treat: Myocardial Infarction | Johns Hopkins ... - December 23rd, 2018 [December 23rd, 2018]
- Myocardial Infarction - Heart Home Page - December 25th, 2018 [December 25th, 2018]
- Myocardial infarction: signs symptoms and treatment ... - December 25th, 2018 [December 25th, 2018]
- ECGs in Acute Myocardial Infarction - ACLS Medical Training - December 25th, 2018 [December 25th, 2018]
- Myocardial Infarction - Eccles Health Sciences Library - December 27th, 2018 [December 27th, 2018]
- Myocardial Infarction: Practice Essentials, Background ... - December 27th, 2018 [December 27th, 2018]
- Myocardial infarction - Wikipedia - December 27th, 2018 [December 27th, 2018]
- Nursing Care Plan for Myocardial Infarction | NRSNG - December 29th, 2018 [December 29th, 2018]
- Cardiovascular disease - Myocardial infarction | Britannica.com - January 11th, 2019 [January 11th, 2019]
- Heart Attack (Myocardial Infarction) - Cedars-Sinai - January 11th, 2019 [January 11th, 2019]
- Top 5 MI ECG Patterns You Must Know | LearntheHeart.com - January 11th, 2019 [January 11th, 2019]
- Anterior Myocardial Infarction LITFL ECG Library Diagnosis - January 11th, 2019 [January 11th, 2019]
- Electrocardiography in myocardial infarction - Wikipedia - January 11th, 2019 [January 11th, 2019]
- Myocardial Infarction Therapeutics Market, Share, Growth ... - March 13th, 2019 [March 13th, 2019]
- Heart Attack (Myocardial Infarction) - Drugs.com - April 20th, 2019 [April 20th, 2019]
- STEMI (ST Elevation Myocardial Infarction): diagnosis ... - April 20th, 2019 [April 20th, 2019]
- Heart attack - Symptoms and causes - Mayo Clinic - April 20th, 2019 [April 20th, 2019]
- Cardiovascular models including myocardial infarction ... - April 27th, 2019 [April 27th, 2019]
- Myocardial infarction - Osmosis Video Library - May 1st, 2019 [May 1st, 2019]
- Myocardial Infarction - September 17th, 2019 [September 17th, 2019]
- Creatinine Rises After RAS Inhibitor Initiation Tied to Worse Outcomes - Renal and Urology News - September 19th, 2019 [September 19th, 2019]
- Ventricular Tachycardia Treatment Market Growth in Technological Innovation, Competitive Landscape Mapping the Trends and Outlook - NewsVarsity - September 19th, 2019 [September 19th, 2019]
- FDA Action Alert: Merck and Amarin - BioSpace - September 19th, 2019 [September 19th, 2019]
- Resverlogix Provides Update on BETonMACE Phase 3 Trial Toronto Stock Exchange:RVX - GlobeNewswire - September 19th, 2019 [September 19th, 2019]
- Marijuana Use Linked to Improved Acute-HF Hospital Survival - Medscape - September 19th, 2019 [September 19th, 2019]
- Population Health vs. Personalized Medicine: Lost in Translation? - American Council on Science and Health - September 19th, 2019 [September 19th, 2019]
- Bariatric Surgery Tied to Less MACE in Obesity, Diabetes - Medscape - September 19th, 2019 [September 19th, 2019]
- A Novel Algorithm for Improving the Diagnostic Accuracy of Prehospital ST-Elevation Myocardial Infarction - DocWire News - September 19th, 2019 [September 19th, 2019]
- Shock and Awe: ARNI for Acute HF May Be Safely Started in ICU - Medscape - September 19th, 2019 [September 19th, 2019]
- Global Myocardial Infarction Treatment Market Will Reach USD 1726.3 million by end of 2022 - Market News Store - September 19th, 2019 [September 19th, 2019]
- Frequency and Factors Related to Not Receiving Acute Reperfusion Therapy in Patients with ST Elevation Myocardial Infarction; A Single Specialty... - September 19th, 2019 [September 19th, 2019]
- Research Offers 10-Year Forecast on Myocardial Infarction Treatment Market - Rapid News Network - September 19th, 2019 [September 19th, 2019]
- University of Colorado study suggests Cannabis aids in surviving heart... - Communities Digital News - September 19th, 2019 [September 19th, 2019]
- SRH part of regional system award recognizing care for heart attacks - Index-Journal - September 19th, 2019 [September 19th, 2019]
- TherOx Announces Key SuperSaturated Oxygen Therapy Presentations at TCT 2019 - Yahoo Finance - September 19th, 2019 [September 19th, 2019]
- Incidence, Characteristics and Outcomes in Very Young Patients with ST Segment Elevation Myocardial Infarction - DocWire News - September 19th, 2019 [September 19th, 2019]
- Health Recovery After Acute MI Similar in Young Adults With and Without Diabetes - The Cardiology Advisor - September 19th, 2019 [September 19th, 2019]
- Rapid Diagnosis Protocol for Chest Pain Does Not Improve Outcomes - Diagnostic and Interventional Cardiology - September 19th, 2019 [September 19th, 2019]
- Diagnosis of Myocardial Infarction At Autopsy: AECVP Reappraisal in the Light of the Current Clinical Classification - DocWire News - September 19th, 2019 [September 19th, 2019]
- Global Myocardial Infarction Drug Market 2019 BioCardia, Inc., Biscayne Pharmaceuticals, Inc., Capricor Therapeutics, Inc., Cell - Market News Times - September 19th, 2019 [September 19th, 2019]
- Abiomed to Highlight Importance of Optimal PCI Treatment to Improve Outcomes for High-Risk Patients at TCT 2019 - Yahoo Finance - September 19th, 2019 [September 19th, 2019]
- ENTRUST-AF PCI Supports Safety of Dual Therapy With Edoxaban - Medscape - September 19th, 2019 [September 19th, 2019]
- Preoperative opioid use leads to perioperative consequences in foot and ankle surgery - Healio - September 19th, 2019 [September 19th, 2019]
- CV, General Safety of Long-Term PPI Use Examined - The Cardiology Advisor - September 19th, 2019 [September 19th, 2019]
- Effect of Delayed vs Immediate Interventions in Transient STEMI - The Cardiology Advisor - September 19th, 2019 [September 19th, 2019]
- Cardiorenal Disease Is the Most Common CVD Manifestation in Patients With T2D - Endocrinology Advisor - September 19th, 2019 [September 19th, 2019]
- DAPA-HF Published: 'Stunning Consistent Benefit With Dapagliflozin' - Medscape - September 19th, 2019 [September 19th, 2019]
- Geomagnetic Disturbances and Cardiovascular Mortality Risk - On Health - BMC Blogs Network - September 19th, 2019 [September 19th, 2019]
- Reconsidering the Safety of Intravenous Thrombolysis for Ischemic Stroke After Recent Myocardial Infarction - Neurology Advisor - September 19th, 2019 [September 19th, 2019]
- The Lowdown on Lipoprotein(a) - Medscape - October 9th, 2019 [October 9th, 2019]
- Protamine use found to significantly reduce reoperations for patients who undergo carotid endarterectomy - Vascular News - October 9th, 2019 [October 9th, 2019]
- Left Main Treated With PCI or CABG Have Similar Outcomes at Five Years - Diagnostic and Interventional Cardiology - October 9th, 2019 [October 9th, 2019]
- Sen. Sanders released from the hospital after heart attack - WXYZ - October 9th, 2019 [October 9th, 2019]
- E-Selectin Gene Haplotypes are Associated with the Risk of Myocardial Infarction - DocWire News - October 9th, 2019 [October 9th, 2019]
- BioVentrix Enrolls and Treats First Patient in REVIVE-HF European RCT for Ischemic Heart Failure Patients - P&T Community - October 9th, 2019 [October 9th, 2019]
- Quantitative Flow Ratio guided Residual Functional SYNTAX Score for Risk Assessment in Patients with ST-Segment Elevation Myocardial Infarction... - October 9th, 2019 [October 9th, 2019]
- Coronary Calcium Scan: The Role of Calcium Scoring in Preventing a First Myocardial Infarction - Consultant360 - October 9th, 2019 [October 9th, 2019]
- Sanders plans to 'change the nature' of campaign after heart attack - New York Post - October 9th, 2019 [October 9th, 2019]
- Early MI Linked to High Recurrent Events, Mortality - Medscape - October 9th, 2019 [October 9th, 2019]
- Sudden Cardiac Arrest and Ventricular Arrhythmias following first type I Myocardial Infarction in the Contemporary Era - DocWire News - October 9th, 2019 [October 9th, 2019]
- E-Cigarette Use and Myocardial Infarction - Physician's Weekly - October 9th, 2019 [October 9th, 2019]
- Sen. Bernie Sanders had heart attack; chest pains diagnosed as myocardial infarction - KIRO Seattle - October 9th, 2019 [October 9th, 2019]