Statins for the primary prevention of cardiovascular events in elderly patients: a picture from clinical practice without strong evidence from clinical trials

Statins have been demonstrated to be beneficial for secondary prevention of cardiovascular (CV) events also in the elderly. However, a great debate is ongoing about the actual effectiveness in the primary prevention in this patient group. Notwithstanding the lack of strong evidence for primary prevention of CV events in the elderly, statins might be prescribed to elderly in general practice, thus contributing to increase the economic burden of this drug type on the Italian National Health System expenditure. We have conducted an analysis using the general practice database of Caserta-1 Local Health Unit. We selected subjects that received at least one statin prescriptions during the years 2004-2005. We stratified statin users according to CV primary and secondary prevention. The data show that 17.3% of statin users are aged 75 and older (median 78). Prevalence of statin use in elderly patients is 10.0%. Primary prevention of CV events represents the most frequent indication of use of statins in this age group (62.7%). In particular, 30.6% of elderly people receiving statins for primary prevention are new users. Almost 40% of statin users aged 75 and older received only one to five statin prescriptions within the study period. Our data show a wide use of statins in patients aged 75 and older, particularly for primary prevention of CV events. These results should be interpreted also in relation to economics. Alternatively the risk of statin-related adverse events increases with age because of polytherapy and reduced hepatic and renal function. Economic impact and a benefit risk ratio assessment of statin therapy for primary prevention of CV events in elderly people should be taken into account.