Statins are cost-effective for CVD prevention in older adults

Statins are cost-effective for primary prevention of cardiovascular disease in adults who are at least 75 years old, according to a simulation model.

Lead researcher Michelle C. Odden, PhD, of the College of Public Health and Human Sciences at Oregon State University in Corvallis, and colleagues published their findings online in the Annals of Internal Medicine on April 20.

They mentioned that 30 percent of the 19 million U.S. adults between 75 and 94 years old had cardiovascular disease in 2014. However, guidelines such as those from the American College of Cardiology and American Heart Association were limited and conflicting in older adults, according to the researchers. In addition, people in that age category have been underrepresented in trials that examined statins for primary prevention.

In this study, the researchers used the Cardiovascular Disease Policy Model, a Marvov model that includes data on the incidence, prevalence, mortality and cost of coronary heart disease (CHD) and stroke in U.S. adults from 35 to 94 years old. They then ran a simulation of adults from 75 to 94 years old starting in 2014 and ending in 2023.

During that time period, the researchers projected people in that age category would have 2.5 million MIs and 3.1 million CHD deaths, which would cost an estimated $881 billion. If all adults from 75 to 94 years old who had cardiovascular disease were treated with statins in the next decade, cardiovascular disease-related healthcare costs would decrease by approximately $14 billion, according to the model.

The researchers wrote adults who were 75 or older in the National Health and Nutrition Examination Survey had an estimated 10-year cardiovascular disease risk of more than 7.5 percent. They added that if statins did not affect functional limitation or cognitive impairment, they would prevent MIs and CHD deaths and be cost-effective.

“Although these findings are promising, even a small increased risk for functional limitation or cognitive impairment could offset the cardiovascular benefit,” the researchers wrote. “In addition, our estimates of the value of statin use for primary prevention were susceptible to varying assumptions about effectiveness and cost. Because of the sensitivity of our findings to these parameters, studies to quantify the potential benefits and harms of statin use in older adults are paramount.”