Lipid-Lowering Agents in Older Individuals: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Oscar J. Ponce, Laura Larrea-Mantilla, Bianca Hemmingsen, Valentina Serrano, Rene Rodriguez-Gutierrez, Gabriela Spencer-Bonilla, Neri Alvarez-Villalobos, Khaled Benkhadra, Abdullah Haddad, Michael R. Gionfriddo, Larry J. Prokop, Juan Brito Campana, Mohammad H Murad

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: The efficacy of lipid-lowering agents on patient-important outcomes in older individuals is unclear. METHODS: We included randomized trials that enrolled individuals aged 65 years or older and that included at least 1 year of follow-up.Pairs of reviewers selected and appraised the trials. RESULTS: We included 23 trials that enrolled 60,194 elderly patients. For primary prevention, statins reduced the risk of coronary artery disease [CAD; relative risk (RR): 0.79, 95% CI: 0.68 to 0.91] and myocardial infarction (MI; RR: 0.45, 95% CI: 0.31 to 0.66) but not all-cause or cardiovascular mortality or stroke. These effects were imprecise in patients with diabetes, but there was no significant interaction between diabetes status and the intervention effect. For secondary prevention, statins reduced all-cause mortality (RR: 0.80, 95% CI: 0.73 to 0.89), cardiovascular mortality (RR: 0.68, 95% CI: 0.58 to 0.79), CAD (RR: 0.68, 95% CI: 0.61 to 0.77), MI (RR: 0.68, 95% CI: 0.59 to 0.79), and revascularization (RR: 0.68, 95% CI: 0.61 to 0.77). Intensive (vs less-intensive) statin therapy reduced the risk of CAD and heart failure. Niacin did not reduce the risk of revascularization, and fibrates did not reduce the risk of stroke, cardiovascular mortality, or CAD. CONCLUSION: High-certainty evidence supports statin use for secondary prevention in older individuals. Evidence for primary prevention is less certain. Data in older individuals with diabetes are limited; however, no empirical evidence has shown a significant difference based on diabetes status.

Original languageEnglish (US)
Pages (from-to)1585-1594
Number of pages10
JournalThe Journal of clinical endocrinology and metabolism
Volume104
Issue number5
DOIs
StatePublished - May 1 2019

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Meta-Analysis
Randomized Controlled Trials
Lipids
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Medical problems
Computer aided design
Mortality
Primary Prevention
Secondary Prevention
Myocardial Infarction
Fibric Acids
Niacin
Proxy
Coronary Artery Disease
Heart Failure
Stroke

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Lipid-Lowering Agents in Older Individuals : A Systematic Review and Meta-Analysis of Randomized Clinical Trials. / Ponce, Oscar J.; Larrea-Mantilla, Laura; Hemmingsen, Bianca; Serrano, Valentina; Rodriguez-Gutierrez, Rene; Spencer-Bonilla, Gabriela; Alvarez-Villalobos, Neri; Benkhadra, Khaled; Haddad, Abdullah; Gionfriddo, Michael R.; Prokop, Larry J.; Brito Campana, Juan; Murad, Mohammad H.

In: The Journal of clinical endocrinology and metabolism, Vol. 104, No. 5, 01.05.2019, p. 1585-1594.

Research output: Contribution to journalArticle

Ponce, OJ, Larrea-Mantilla, L, Hemmingsen, B, Serrano, V, Rodriguez-Gutierrez, R, Spencer-Bonilla, G, Alvarez-Villalobos, N, Benkhadra, K, Haddad, A, Gionfriddo, MR, Prokop, LJ, Brito Campana, J & Murad, MH 2019, 'Lipid-Lowering Agents in Older Individuals: A Systematic Review and Meta-Analysis of Randomized Clinical Trials', The Journal of clinical endocrinology and metabolism, vol. 104, no. 5, pp. 1585-1594. https://doi.org/10.1210/jc.2019-00195
Ponce OJ, Larrea-Mantilla L, Hemmingsen B, Serrano V, Rodriguez-Gutierrez R, Spencer-Bonilla G et al. Lipid-Lowering Agents in Older Individuals: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. The Journal of clinical endocrinology and metabolism. 2019 May 1;104(5):1585-1594. https://doi.org/10.1210/jc.2019-00195
Ponce, Oscar J. ; Larrea-Mantilla, Laura ; Hemmingsen, Bianca ; Serrano, Valentina ; Rodriguez-Gutierrez, Rene ; Spencer-Bonilla, Gabriela ; Alvarez-Villalobos, Neri ; Benkhadra, Khaled ; Haddad, Abdullah ; Gionfriddo, Michael R. ; Prokop, Larry J. ; Brito Campana, Juan ; Murad, Mohammad H. / Lipid-Lowering Agents in Older Individuals : A Systematic Review and Meta-Analysis of Randomized Clinical Trials. In: The Journal of clinical endocrinology and metabolism. 2019 ; Vol. 104, No. 5. pp. 1585-1594.
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abstract = "BACKGROUND: The efficacy of lipid-lowering agents on patient-important outcomes in older individuals is unclear. METHODS: We included randomized trials that enrolled individuals aged 65 years or older and that included at least 1 year of follow-up.Pairs of reviewers selected and appraised the trials. RESULTS: We included 23 trials that enrolled 60,194 elderly patients. For primary prevention, statins reduced the risk of coronary artery disease [CAD; relative risk (RR): 0.79, 95{\%} CI: 0.68 to 0.91] and myocardial infarction (MI; RR: 0.45, 95{\%} CI: 0.31 to 0.66) but not all-cause or cardiovascular mortality or stroke. These effects were imprecise in patients with diabetes, but there was no significant interaction between diabetes status and the intervention effect. For secondary prevention, statins reduced all-cause mortality (RR: 0.80, 95{\%} CI: 0.73 to 0.89), cardiovascular mortality (RR: 0.68, 95{\%} CI: 0.58 to 0.79), CAD (RR: 0.68, 95{\%} CI: 0.61 to 0.77), MI (RR: 0.68, 95{\%} CI: 0.59 to 0.79), and revascularization (RR: 0.68, 95{\%} CI: 0.61 to 0.77). Intensive (vs less-intensive) statin therapy reduced the risk of CAD and heart failure. Niacin did not reduce the risk of revascularization, and fibrates did not reduce the risk of stroke, cardiovascular mortality, or CAD. CONCLUSION: High-certainty evidence supports statin use for secondary prevention in older individuals. Evidence for primary prevention is less certain. Data in older individuals with diabetes are limited; however, no empirical evidence has shown a significant difference based on diabetes status.",
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AU - Ponce, Oscar J.

AU - Larrea-Mantilla, Laura

AU - Hemmingsen, Bianca

AU - Serrano, Valentina

AU - Rodriguez-Gutierrez, Rene

AU - Spencer-Bonilla, Gabriela

AU - Alvarez-Villalobos, Neri

AU - Benkhadra, Khaled

AU - Haddad, Abdullah

AU - Gionfriddo, Michael R.

AU - Prokop, Larry J.

AU - Brito Campana, Juan

AU - Murad, Mohammad H

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N2 - BACKGROUND: The efficacy of lipid-lowering agents on patient-important outcomes in older individuals is unclear. METHODS: We included randomized trials that enrolled individuals aged 65 years or older and that included at least 1 year of follow-up.Pairs of reviewers selected and appraised the trials. RESULTS: We included 23 trials that enrolled 60,194 elderly patients. For primary prevention, statins reduced the risk of coronary artery disease [CAD; relative risk (RR): 0.79, 95% CI: 0.68 to 0.91] and myocardial infarction (MI; RR: 0.45, 95% CI: 0.31 to 0.66) but not all-cause or cardiovascular mortality or stroke. These effects were imprecise in patients with diabetes, but there was no significant interaction between diabetes status and the intervention effect. For secondary prevention, statins reduced all-cause mortality (RR: 0.80, 95% CI: 0.73 to 0.89), cardiovascular mortality (RR: 0.68, 95% CI: 0.58 to 0.79), CAD (RR: 0.68, 95% CI: 0.61 to 0.77), MI (RR: 0.68, 95% CI: 0.59 to 0.79), and revascularization (RR: 0.68, 95% CI: 0.61 to 0.77). Intensive (vs less-intensive) statin therapy reduced the risk of CAD and heart failure. Niacin did not reduce the risk of revascularization, and fibrates did not reduce the risk of stroke, cardiovascular mortality, or CAD. CONCLUSION: High-certainty evidence supports statin use for secondary prevention in older individuals. Evidence for primary prevention is less certain. Data in older individuals with diabetes are limited; however, no empirical evidence has shown a significant difference based on diabetes status.

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