Intensive statin doses offer no extra benefit for nursing home residents

Older adults living in long-term care facilities experienced a similar risk of mortality and cardiovascular hospitalizations regardless of whether they were taking intensive or more moderate doses of statins, a retrospective study found.

“This lack of benefit should be considered when prescribing statins to vulnerable residents of long-term care facilities who are at potentially increased risk of statin-related adverse events,” wrote lead author Michael A. Campitelli, with the Institute for Clinical Evaluative Sciences, and colleagues in the Canadian Medical Association Journal.

The researchers noted that few patients in randomized trials of statins are older than 75 and even fewer are residents of long-term care facilities, who may be particularly at risk of medication-related adverse events given their prevalence of frailty and polypharmacy. Also, the shorter life expectancies of patients in nursing homes and other care facilities could further shift the risk-benefit balance of statin therapy in this understudied population.

“An observed threefold difference in the median proportion of residents in long-term care facilities receiving statins between high- and low-rate prescribers highlights the uncertainty faced by clinicians when making treatment decisions,” Campitelli et al. wrote.

To shed more light on statin treatment in these patients, the researchers identified 21,808 residents of long-term care facilities in Ontario, Canada, who were prevalent statin users and age 76 or older.

They used drug claims data to identify individuals taking intensive daily doses of a statin, meaning at least 40 mg of atorvastatin, 20 mg of rosuvastatin or 80 mg of simvastatin. All other statin users were categorized as low-dose recipients.

The researchers came up with 4,577 pairs of patients who were well-matched in terms of sex, age, frailty, previous atherosclerotic cardiovascular disease (ASCVD) and propensity score—the primary difference being that one patient in each pair was treated with high-intensity statin doses and the other received moderate doses.

At one year of follow-up, 26.4 percent of patients in the moderate dose group died and 11.5 percent were admitted to the hospital for a cardiovascular event. The corresponding proportions were 25.6 percent and 11.4 percent, respectively, among intensive statin users. Neither between-group difference was determined to be statistically significant, and findings were similar in subgroups with previous ASCVD and those with lower baseline mortality rates.

“It may be prudent to reduce statin doses for specific vulnerable residents who are at increased risk of statin-related adverse events,” Campitelli and coauthors wrote. “Future research and clinical trials should focus on evaluating the efficacy and safety of statin use and dosing, as well as stopping the use of statins, in residents of long-term care facilities to help inform clinical practice.”

Campitelli et al. noted their findings are generally in line with guidelines released by the American College of Cardiology and American Heart Association, which recommend moderate-intensity statins for most adults with ASCVD who are 75 or older.

“Our findings are consistent with the guideline recommendations as most statin users were taking moderate doses, and the nonsignificant association between use of intensive-dose statins and our study outcomes highlights the possibility that the recommendation could be extended to older residents of long-term care facilities with and without atherosclerotic cardiovascular disease,” they wrote.