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Do statins reduce mortality in older people? Findings from a longitudinal study using primary care records
  1. Lisanne Andra Gitsels1,
  2. Ilyas Bakbergenuly2,
  3. Nicholas Steel3 and
  4. Elena Kulinskaya2
  1. 1 Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
  2. 2 School of Computing Sciences, University of East Anglia, Norwich, UK
  3. 3 Norwich Medical School, University of East Anglia, Norwich, UK
  1. Correspondence to Dr Lisanne Andra Gitsels; lisanne.gitsels.11{at}ucl.ac.uk

Abstract

Objective Assess whether statins reduce mortality in the general population aged 60 years and above.

Design Retrospective cohort study.

Setting Primary care practices contributing to The Health Improvement Network database, England and Wales, 1990–2017.

Participants Cohort who turned age 60 between 1990 and 2000 with no previous cardiovascular disease or statin prescription and followed up until 2017.

Results Current statin prescription was associated with a significant reduction in all-cause mortality from age 65 years onward, with greater reductions seen at older ages. The adjusted HRs of mortality associated with statin prescription at ages 65, 70, 75, 80 and 85 years were 0.76 (95% CI 0.71 to 0.81), 0.71 (95% CI 0.68 to 0.75), 0.68 (95% CI 0.65 to 0.72), 0.63 (95% CI 0.53 to 0.73) and 0.54 (95% CI 0.33 to 0.92), respectively. The adjusted HRs did not vary by sex or cardiac risk.

Conclusions Using regularly updated clinical information on sequential treatment decisions in older people, mortality predictions were updated every 6 months until age 85 years in a combined primary and secondary prevention population. The consistent mortality reduction of statins from age 65 years onward supports their use where clinically indicated at age 75 and older, where there has been particular uncertainty of the benefits.

  • cardiovascular diseases
  • epidemiology
  • health records
  • personal

Data availability statement

Data may be obtained from a third party and are not publicly available. For all interested researchers, THIN data are available via QuintilesIMS, subject to ethical approval of the THIN Scientific Review Committee and governance controls.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/fmch-2020-000780

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. For all interested researchers, THIN data are available via QuintilesIMS, subject to ethical approval of the THIN Scientific Review Committee and governance controls.

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    Footnotes

    • Contributors EK is the guarantor. LG implemented the statistical methods by carrying out stages 1–2 of the main analysis and drafted the manuscript. IB extracted THIN data and implemented the statistical methods by carrying out stages 3–4 of the main analysis. NS provided guidance on the presenting and implications of results and contributed to writing the manuscript. EK designed the study, provided guidance on the statistical methods and interpretation of the results, and contributed to writing the manuscript. All authors were involved in revisions, read and approved the final manuscript.

    • Funding This study was funded by The Institute and Faculty of Actuaries (N/A) and ESRC funded Business and Local Government Data Research Centre (ES/L011859/1).

    • Competing interests This work was supported by the ESRC funded Business and Local Government Data Research Centre (ES/L011859/1 to LG and EK) and the Institute and Faculty of Actuaries (IFoA) (Grant IB, NS and EK). The authors have declared that no competing interests exist.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.