Primary Prevention With Statin Therapy in the Elderly
New Meta-Analyses From the Contemporary JUPITER and HOPE-3 Randomized Trials
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
The use of statin therapy for secondary prevention is established in all age groups.1 However, in primary prevention, current cardiovascular guidelines in the United States and Canada describe the role for statin therapy in the elderly as uncertain.
To examine this question, we performed a meta-analysis of age-specific outcome data from 2 recent primary prevention statin trials, JUPITER (Justification for Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin)2 and HOPE-3 (Heart Outcomes Prevention Evaluation).3 We combined new subgroup data from these contemporary trials using a fixed-effect meta-analysis with inverse variance weighting of the log hazard ratios by age group (<65, 65–<70, and ≥70 years) using the meta package in R (R version 3.2.3). The pooled treatment effect within each subgroup was estimated, as was the between-subgroup heterogeneity statistic, Q.
The JUPITER trial, published in 2008, evaluated rosuvastatin 20 mg daily among 17 802 men and women free of cardiovascular disease with low-density lipoprotein cholesterol levels <130 mg/dL and high-sensitivity C-reactive protein levels >2 mg/L.2 For the end point of hard atherosclerotic cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death), the JUPITER trial overall reported a 47% reduction in risk (hazard ratio [HR], 0.53; 95% …