Old Age and Outcome After Primary Angioplasty for Acute Myocardial Infarction

OBJECTIVES: To assess the influence of age as an independent factor determining the prognosis and outcome of patients with acute myocardial infarction (AMI) treated using primary percutaneous coronary intervention (PCI). DESIGN: A retrospective analysis from a dedicated database. SETTING: A high‐volume interventional cardiology center in the Netherlands. PARTICIPANTS: Four thousand nine hundred thirty‐three consecutive patients with AMI. MEASUREMENTS: Baseline characteristics and clinical outcomes after 30 days and 1 year were compared according to age categorized in three groups: younger than 65, 65 to 74, and 75 and older. A more‐detailed analysis was performed with six age groups, from younger than 40 to 80 and older. RESULTS: Of the 4,933 consecutive patients with AMI treated with PCI between 1992 and 2004, 643 were aged 75 and older. Multivariate analysis revealed that patients aged 65 to 75 had a greater risk of 1‐year mortality than those younger than 65 (adjusted odds ratio (AOR)=1.57, 95% confidence interval (CI)=1.15–2.16) and that those aged 75 and older had a greater risk of 1‐year mortality than those younger than 65 (AOR=3.03, 95% CI=2.14–4.29). CONCLUSION: In this retrospective analysis, older age was independently associated with greater mortality after PCI for AMI. Patients aged 65 and older had a higher risk of mortality than younger patients, and those aged 75 and older had the highest risk of mortality.     

Age‐Varying Association Between Statin Use and Incident Alzheimer's Disease

OBJECTIVES: To determine whether risk reduction of statins for Alzheimer's disease (AD) varies by age or presence of apolipoprotein E (APOE) ?4 allele. DESIGN: A cohort of cognitively intact elderly participants was assessed biennially for dementia and AD. SETTING: Community based. PARTICIPANTS: Three thousand three hundred ninety‐two members of a health maintenance organization (HMO) aged 65 and older and without dementia. MEASUREMENTS: Statin use was identified from the HMO pharmacy database, and proportional hazards models were applied with statin use as a time‐dependent covariate to assess the association between statins and AD and the modifying effects of age and the APOE ?4 allele. RESULTS: Over an average of 6.1 years of follow‐up of 3,099 participants, 263 participants developed probable AD. The adjusted hazard ratio (aHR) for statin use was 0.62 (95% confidence interval (CI)=0.40–0.97) for AD in models including demographic characteristics and vascular risk factors as covariates. The strength of the association between statins and AD diminished with age (statin‐by–age at entry interaction P=.04); the aHR in those younger than 80 was 0.44 (95% CI=0.25–0.78), versus 1.22 (95% CI=0.61–2.42) for aged 80 and older. The interaction term for statin use–by–APOE ?4 was not significant (P=.65). CONCLUSION: This enlarged study confirms earlier findings that statin therapy in early old age, but not in late age, may be associated with a lower risk of AD. The relationship between statin use and AD was consistent across APOE genotypes.     

A propensity-matched study of outcomes of chronic heart failure (HF) in younger and older adults

The majority of heart failure (HF) patients are older adults and most HF-related adverse events occur in these patients. However, the independent association of age and outcomes in HF is not clearly determined. We categorized 7788 ambulatory HF patients who participated in the Digitalis Investigation Group (DIG) trial as younger (< 65 years) and older (> or = 65 years). Propensity scores for older age were calculated for each patient and used to match 2381 pairs of younger and older patients. The associations of older age with mortality and hospitalization during a median 40 months of follow-up were assessed using matched Cox regression models. All-cause mortality occurred in 877 older patients versus 688 younger patients (hazard ratio when older age was compared with younger age (HR)=1.26; 95% confidence interval (CI)=1.12-1.41; p<0.0001). Older patients, when compared with propensity-matched younger patients, also had significantly higher mortality rates due to cardiovascular causes (HR=1.14; 95% CI=1.00-1.30; p=0.044) and worsening heart failure causes (HR=1.32; 95% CI=1.07-1.62; p=0.009). No significant association was found between age and hospitalization due to all causes (HR=1.08; 95% CI=0.99-1.18; p=0.084) and cardiovascular causes (HR=1.03; 95% CI=0.93-1.13; p=0.622). However, hospitalization due to HF was significantly increased in older patients (HR=1.14; 95% CI=1.01-1.28; p=0.041). In ambulatory HF patients, older age although associated with increased mortality, was not associated with increased hospitalizations except for those due to worsening HF.     

The Poor Outcome of Ischemic Stroke in Very Old People: A Cohort Study of Its Determinants

OBJECTIVES: To assess how much of the excess risk of poor outcome from stroke in people aged 80 and older aging per se explains, independent of other prognostic determinants.
DESIGN: Cohort, observational.
SETTING: University hospital.
PARTICIPANTS: One thousand five hundred fifty-five patients with first-ever ischemic stroke consecutively referred to an in-hospital Clinical Pathway program were studied.
MEASUREMENTS: The relationship between age and 1-month outcome (death, disability (modified Rankin Scale 3–5), and poor outcome (modified Rankin Scale 3–6)) was assessed, with adjustment for several prognostic factors.
RESULTS: Six hundred twelve patients aged 80 and older showed worse outcome after 1 month than those who were younger, in terms of mortality (19% vs 5%, hazard ratio (HR)=3.85, 95% confidence interval (CI)=2.8–5.4) and disability (51% vs 33%, odds ratio (OR)=3.16, 95% CI=2.5–4.0), although in multivariate models, the adjusted HR for mortality decreased to 1.47 (95% CI=1.0–2.16) and the ORs for disability and poor outcome decreased to 1.76 (95% CI=1.32–2.3.) and 1.83 (95% CI=137–2.43), respectively. Stroke severity, the occurrence of at least one medical complication, and premorbid disability explained most of the risk excess in the oldest-old.
CONCLUSION: Stroke outcome is definitely worse in very old people, and most of the excess risk of death and disability is attributable to the higher occurrences of the most-severe clinical stroke syndromes and of medical complications in the acute phase. These represent potential targets for preventive and therapeutical strategies specifically for elderly people.     

Short-term mortality in relation to age and comorbidity in older adults with community-acquired bacteremia: a population-based cohort study

OBJECTIVES: To assess 30‐day mortality from bacteremia in relation to age and comorbidity and the association between age and mortality with increasing comorbidity. DESIGN: Population‐based cohort study. SETTING: North Jutland County, Denmark. PARTICIPANTS: Adults in medical wards with community‐acquired bacteremia, 1995 to 2004. MEASUREMENTS: Smoothed mortality curves and computed mortality rate ratios (MRRs) using Cox regression analysis. RESULTS: Two thousand eight hundred fifty‐one patients, 851 aged 15 to 64, 1,092 aged 65 to 79, and 909 aged 80 and older were included. Mortality increased linearly with age. Compared with patients younger than 65, adjusted MRRs in patients aged 65 to 79 and 80 and older were 1.5 (95% confidence interval (CI)=1.2–2.0) and 1.8 (95% CI=1.4–2.3), respectively. Mortality also increased with level of comorbidity. Compared with patients with low comorbidity, adjusted MRRs in patients with medium and high comorbidity were 1.5 (95% CI=1.2–1.8) and 1.7 (95% CI=1.4–2.2), respectively. Regardless of the level of comorbidity, MRRs were consistently higher in older than in younger patients. CONCLUSION: Older age and greater comorbidity predicted mortality, and increasing age‐related comorbidity did not explain the effect of age.     

Elderly patients undergoing major vascular surgery: risk factors and medication associated with risk reduction

This study assesses risk factors in elderly vascular surgery patients and to evaluate whether perioperative cardiac medication can reduce postoperative mortality rate. In a cohort study, 1693 consecutive patients > or =65 years undergoing major non-cardiac vascular surgery were preoperatively screened for cardiac risk factors and medication. During follow-up (median: 8.2 years), mortality was noted. Hospital mortality occurred in 8.1% and long-term mortality in 28.5%. In multivariate analysis, age, coronary artery disease, heart failure, cerebrovascular disease, renal failure and diabetes were significantly associated with increased hospital and long-term mortality. Perioperative aspirin (OR: 0.53, 95% confidence interval: 0.34-0.83), beta-blockers (OR: 0.32, 95% CI: 0.19-0.54) and statins (OR: 0.35, 95% CI: 0.18-0.68) were significantly associated with reduced hospital mortality. In addition, aspirin (HR: 0.65, 95% CI: 0.53-0.81), angiotensin-converting enzyme (ACE)-inhibitors (HR: 0.74, 95% CI: 0.59-0.92), beta-blockers (HR: 0.61, 95% CI: 0.48-0.76) and statins (HR: 0.65, 95% CI: 0.49-0.87) were significantly associated with reduced long-term mortality. Heterogeneity tests revealed a gradient decrease of mortality risk in patients from low to high age using statins (p=0.03). In conclusion, age is an independent predictor of hospital and long-term mortality in elderly patients undergoing major vascular surgery. Aspirin, ACE-inhibitors, beta-blockers and statins reduce long-term mortality risk. Especially the very elderly may benefit from statin therapy.     

Patients using statin treatment within 24 h after admission for ST-elevation acute coronary syndromes had lower mortality than non-users: a report from the first Euro Heart Survey on acute coronary syndromes.

AIMS: Statins provide effective secondary prevention in cardiovascular disease. However, it remains uncertain how soon statins should be started after an acute coronary syndrome (ACS). Recently published trials suggest starting before discharge. We hypothesize that statins should be initiated without delay. METHODS AND RESULTS: Data from a large cohort of 10,484 consecutive patients with an ACS were analysed. Of this cohort, 1426 first-time statin receivers and survivors of the first 24 h were compared with 6771 first-day survivors not receiving statin therapy. A propensity score for the likelihood of receiving statin therapy within 24 h was developed and used with other established risk factors in a multivariable analysis. There was a significantly reduced all-cause 7-day mortality in patients receiving early statin therapy [0.4 vs. 2.6%, unadjusted hazard ratio (HR) 0.16, 95% confidence interval (CI) 0.08-0.37, adjusted HR 0.34, 95% CI 0.15-0.79]. Statistical significance was observed in patients presenting with STE-ACS (adjusted HR 0.17, 95% CI 0.04-0.70) and not in NSTE-ACS patients. However, no statistical evidence of heterogeneity in treatment effect was observed between these groups. CONCLUSION: These data suggest that very early statin therapy is associated with reduced mortality in patients presenting with STE-ACS; however, these findings have to be confirmed by prospective, randomized controlled trials before firm treatment recommendations can be given.     

Effects of statin therapy on arrhythmic events and survival in patients with nonischemic dilated cardiomyopathy.

OBJECTIVES: We sought to evaluate whether statins were associated with a survival benefit and significant attenuation in life-threatening arrhythmias in patients with nonischemic dilated cardiomyopathy. BACKGROUND: Statins are associated with a reduction in appropriate implantable cardioverter-defibrillator (ICD) therapy in patients with coronary artery disease and improved clinical status in nonischemic dilated cardiomyopathy. METHODS: The effect of statin use on time to death or resuscitated cardiac arrest and time to arrhythmic sudden death was evaluated in 458 patients enrolled in the DEFINITE (DEFIbrillators in Non-Ischemic cardiomyopathy Treatment Evaluation) study. The effect of statin use on time to first appropriate shock was analyzed only in the 229 patients who were randomized to ICD therapy. RESULTS: The unadjusted hazard ratio (HR) for death among patients on versus those not on statin therapy was 0.22 (95% confidence interval [CI] 0.09 to 0.55; p = 0.001). When controlled for statin effects, ICD therapy was associated with improved survival (HR 0.61; 95% CI 0.38 to 0.99; p = 0.04). There was one arrhythmic sudden death in the 110 patients receiving statin therapy (0.9%) versus 18 of 348 patients not receiving statins (5.2%; p = 0.04). The unadjusted HR for arrhythmic sudden death among patients on versus those not on statin therapy was 0.16 (95% CI 0.022 to 1.21; p = 0.08). The HR for appropriate shocks among patients on versus those not on statin therapy was 0.78 (95% CI 0.34 to 1.82) after adjustment for baseline differences in the two groups. CONCLUSIONS: Statin use in the DEFINITE study was associated with a 78% reduction in mortality. This reduction was caused, in part, by a reduction in arrhythmic sudden death. These findings should be confirmed in a prospective, randomized clinical trial.     

Prognostic Significance of Newly Diagnosed Atrial Fibrillation After Acute Myocardial Infarction: A Study of 184,980 Medicare Patients

We aimed to determine whether newly diagnosed atrial fibrillation (AF) predicted cardiovascular events and death after myocardial infarction (AMI) in a large nationwide cohort of patients. All Medicare beneficiaries aged >65 years who were discharged alive after a diagnosis of AMI between January 1, 2007 and December 31, 2008 were identified. Main exposure was a diagnosis of AF during admission or within 90 days after discharge. Primary outcome was a composite of recurrent AMI, stroke and all-cause mortality. Secondary outcomes were each of recurrent AMI, stroke and all-cause mortality. We used Cox proportional hazards regression to assess the relationship between AF and time-to-event outcomes with follow up ending at 3 years. Of 184,980 patients, 9.1 % had AF; 40.6 % were male; 82.8 % were non-Hispanic whites. Mean age was 79.1 ± 8.1 years. Overall, 15.7 % had subsequent AMI, 5.7 % had stroke and 43.9 % died during a mean follow up of 26.4 months. AF was associated with a significantly increased risk of the primary outcome (Hazard ratio (HR) = 1.10; 95 % confidence interval (CI): 1.07–1.12). AF was also separately associated with significantly increased risk of recurrent AMI (HR = 1.09; 95 % CI: 1.04–1.14), stroke (HR = 1.29; 95 % CI: 1.21–1.37), and death (HR = 1.09; 95 % CI: 1.06–1.12). Neither age, race nor sex modified the effects of AF on primary or secondary outcomes. In conclusion, AF is a significant predictor of adverse cardiovascular outcomes and mortality after AMI. Further studies are needed to understand mechanisms by which AF alters outcomes in survivors of AMI.     

Threshold level of low-density lipoprotein cholesterol for the short-term benefit of statin therapy in the acute phase of myocardial infarction

Background:

Little is known about the threshold level of low‐density lipoprotein cholesterol (LDL‐C) for statin therapy in acute myocardial infarction (AMI).

Hypothesis:

The aim of this study was to investigate the short‐term benefit of the statin in post‐MI patients with low LDL‐C levels.

Methods:

Between November 2005 and January 2008, 6866 statin‐naive patients were selected from the Korea AMI registry. Major adverse cardiac event (MACE) was defined as a composite of death, recurrent MI, and revascularizations.

Results:

The 6‐month MACE and mortality showed a U‐shaped curve, with the lowest rate at 114–122 mg/dL. Propensity scores for statin use were calculated for patients with LDL‐C ≤ 113 mg/dL, and they were used to match the patients who received statin (statin user, n = 1031) with those who did not receive it (statin nonuser, n = 1031). The 6‐month MACE was not significantly different between statin users and statin nonusers (9.4% vs 11.0%; hazard ratio [HR]: 0.847, 95% confidence interval [CI]: 0.646‐1.111, P = 0.230), whereas the 6‐month mortality was significantly lower in statin users (7.2% vs 9.7%; HR: 0.728, 95% CI: 0.539–0.984, P = 0.039). However, when the analyses were repeated in the patients with LDL‐C ≤ 105 mg/dL, not only the 6‐month MACE (9.5% vs 9.9%; HR: 0.945, 95% CI: 0.700–1.277, P = 0.713) but also the 6‐month mortality (7.0% vs 8.7%; HR: 0.793, 95% CI: 0.566–1.111, P = 0.177) was not significantly different between statin users and statin nonusers (n = 876 in each group).

Conclusions:

The beneficial effects of statin therapy seem to vanish when LDL‐C is below a certain level in AMI patients. © 2011 Wiley Periodicals, Inc. Jeong, Kim and Chae received funding from the Korean Society of Cardiology. J.H. Lee, Yang, H.S. Park and Chae received grants from GlaxoSmithKline and Pfizer.     

Prognostic effect of exercise capacity on mortality in older adults with diabetes mellitus

OBJECTIVES: To investigate the prognostic effect of exercise capacity in older individuals with diabetes mellitus. DESIGN: Retrospective data review in a clinic‐based cohort. SETTING: Veterans Affairs Medical Centers in Washington, District of Columbia, and Palo Alto, California. PARTICIPANTS: Two thousand eight hundred sixty‐seven men aged 50 to 87 with type 2 diabetes mellitus. MEASUREMENTS: Exercise tolerance testing with fitness categories based on peak metabolic equivalents of task (METs) achieved adjusted for age. All‐cause mortality in age groups 50 to 65 (Group 1; n=1,658) and older than 65 (Group 2; n=1,209) was analyzed using adjusted Cox proportional hazards models. RESULTS: After a mean ± standard deviation follow‐up period of 7.8 ± 5.1 years, there were 324 deaths in Group 1 (20%) and 464 in Group 2 (38%). For each 1‐MET increase in exercise capacity, mortality was 18% lower for the entire cohort (hazard ratio (HR)=0.82, 95% confidence interval (CI)=0.79–0.86), 23% lower for Group 1 (HR=0.77, 95% CI=0.73–0.82), and 16% lower for Group 2 (HR=0.84, 95% CI=0.8–0.89). When fitness categories were considered, the mortality risk was 30% to 80% lower for those who achieved more than 4 METs in both age groups. CONCLUSION: Augmented exercise capacity is associated with lower risk of mortality in people with type 2 diabetes mellitus aged 50 to 65 as well as in those older than 65. Thus, physical fitness, as represented by exercise capacity, lowers mortality risk in people with diabetes mellitus irrespective of age. These findings suggest that healthcare providers should be cognizant of the level of exercise capacity in individual patients and encourage a physically active lifestyle regardless of age.     

Therapy with hydroxymethylglutaryl coenzyme a reductase inhibitors (statins) and associated risk of incident cardiovascular events in older adults: evidence from the Cardiovascular Health Study

BACKGROUND: Recommendations to treat older adults with hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) for the primary prevention of coronary heart disease events are supported by a single clinical trial restricted to adults 73 years or younger with low levels of high-density lipoprotein cholesterol. METHODS: We investigated the association of statin use with incident cardiovascular disease and all-cause mortality during up to 7.3 years' follow-up of 1250 women and 664 men from the Cardiovascular Health Study. Study participants were 65 years and older and free of cardiovascular disease at baseline. They received drug therapy to lower cholesterol levels at baseline or no treatment with a recommendation for therapy according to the National Cholesterol Education Program guidelines. Use of these drugs was assessed annually. We used proportional-hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for confounding variables. RESULTS: We found 382 incident cardiovascular events (159 myocardial infarctions, 159 strokes, and 64 deaths due to coronary heart disease) and 362 total deaths from June 1, 1989, to May 31, 1997. Compared with no use of drugs to lower cholesterol levels, statin use was associated with decreased risk of cardiovascular events (multivariate HR, 0.44; 95% CI, 0.27-0.71) and all-cause mortality (HR, 0.56; 95% CI, 0.36-0.88). Similar associations were observed among participants 74 years or older at baseline. CONCLUSIONS: Use of statins was associated with decreased risk of incident cardiovascular events among elderly adults. These findings lend support to the National Cholesterol Education Program guidelines, which recommend therapy for the lowering of cholesterol levels for older adults with hypercholesterolemia.     

Impact of statin therapy on renal function and long-term prognosis in acute coronary syndrome patients with chronic kidney disease

A recent study showed that statins reduce cardiovascular events in stable coronary artery disease patients with chronic kidney disease (CKD). However, it remains unclear whether acute coronary syndrome (ACS) patients with CKD benefit from statins. A total of 501 patients with ACS who underwent successful percutaneous coronary intervention were investigated and CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/minute/1.73 m(2) at discharge. Three hundred and twenty-four of 501 patients (64.7%) had CKD and 173 patients (34.5%) received statins. The patients with CKD were older and had higher blood pressure than those without CKD. With a mean follow-up of 5.2 years, irrespective of treatment assignment, 74 patients with CKD experienced cardiac events (22.8%) in comparison to 25 without CKD (14.1%, HR 1.81; 95% CI 1.15-2.84, P = 0.0095). Cardiac events occurred in only 18 of the patients with CKD treated with statins (16.2%) and in 56 of those treated with CKD without statins (26.3%, HR 0.58; 95% CI 0.34-0.98, P = 0.039), whereas, no significant reduction of the events was observed in the patients without CKD treated with statins versus without having statins (P = 0.130). These data indicate that statin therapy reduces cardiac events in ACS patients with CKD.     

Short-term mortality of bacteraemia in elderly patients with haematological malignancies

Bacterial infections are important complications in patients with haematological malignancies. We compared the outcome of bacteraemia among elderly and younger patients with haematological malignancies, and evaluated the impact of comorbidity on this association using population-based registries from 1992 to 2002. Among 358 patients with an incident haematological malignancy and an episode of bacteraemia, 207 (58%) were older than 60 years and 37 (10%) older than 80 years. The 7-d mortality was 10% among patients younger than 60 years, 21% among patients aged 60-79 years, and 27% for patients older than 80 years. When compared with patients younger than 60 years, the adjusted mortality rate ratios (MRRs) were 1.9 [95% confidence interval (CI): 0.9-3.8] for patients aged 60-79 years and 1.6 (95% CI: 0.6-4.2) for patients older than 80 years. The 30-d mortality was 23% among patients younger than 60 years of age, 35% among patients aged 60-79 years, and 54% among patients 80 years or older. Adjusted MRRs were 1.7 (95% CI: 1.1-2.7) and 2.3 (95% CI: 1.2-4.3), respectively. We found that increasing age was associated with increased mortality from bacteraemia in patients with haematological malignancies. An increased burden of comorbidity among the elderly did not explain this association.     

Efficacy of Surgery and Adjuvant Therapy in Older Patients With Colorectal Cancer: A STROBE-compliant article

The present study aimed to assess the efficacy of surgery and adjuvant therapy in older patients (age ≥70 years) with colorectal cancer (CRC). Older CRC patients are under-represented in available clinical trials, and therefore their outcomes after receiving surgery and adjuvant therapy are unclear. From two prospective Swedish databases, we assessed a cohort of 1021 patients who underwent curative surgery for stage I, II, or III primary CRC, with or without adjuvant chemotherapy/radiotherapy. Of the patients with colon cancer (n = 467), 182 (39%) were aged <70 years, 162 (35%) aged 70 to 80 years, and 123 (26%) were aged ≥80 years. Of rectal cancer patients (n = 554), 264 (48%) were aged <70 years, 234 (42%) aged 70 to 80 years, and 56 (10%) aged ≥80 years. Older patients with either colon or rectal cancer had higher comorbidity than did younger patients. Older patients with colon cancer had equivalent postoperative morbidity and 30-day mortality to younger patients. Rectal cancer patients aged ≥80 years had a higher 30-day mortality than younger patients (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.6–4.55; P = 0.03). For either colon or rectal cancer, adjuvant chemotherapy compromised the 5-year overall survival (OS) of older patients with stage II disease and had no effect on those with stage III disease. Receiving adjuvant chemotherapy was a poor factor of OS for older patients with either colon (HR 1.88, 95% CI: 1.20–4.35, P = 0.03) or rectal cancer (HR 1.72, 95% CI: 1.05–2.26, P = 0.004). Preoperative short-course radiotherapy improved both OS and local control for older patients with stage III rectal cancer and had no effect on those with stage II disease. Radiotherapy was a favorable factor for the OS of the older patients with rectal cancer (HR 0.42, 95% CI: 0.21–3.57, P = 0.01). In conclusion, Older CRC patients had equal safety of surgery as younger patients, except rectal cancer patients aged ≥80 years that had a higher mortality. Adjuvant 5FU-based chemotherapy did not benefit older CRC patient, while neoadjuvant radiotherapy improved the prognosis of older patients with stage III rectal cancer.     

Statin treatment following coronary artery stenting and one-year survival

OBJECTIVES: We assessed the influence of statin therapy given after the procedure on one-year survival of patients treated with coronary artery stenting. BACKGROUND: Coronary artery stenting is currently a common treatment option for patients with symptomatic coronary artery disease (CAD). Although several secondary prevention trials have demonstrated improved survival achieved with statin therapy in conservatively treated patients with CAD, it is not known whether this benefit can also be expected in patients undergoing percutaneous coronary interventions with intraluminal stenting. METHODS: This study included 4,520 patients younger than 80 years who underwent coronary artery stenting and were discharged from the hospital in the period October 1995 through September 1999. We compared one-year mortality of 3,585 patients who received statins after stenting with that of 935 patients who did not. RESULTS: The mortality rate at one year was 2.6% among patients who received statins and 5.6% among those who did not. Thus, statin therapy at discharge was associated with an unadjusted odds ratio (OR) of 0.46 (95% confidence interval [CI], 0.33 to 0.65), indicating a 54% reduction in the risk of death at one year. After adjusting for other covariates, the risk reduction associated with statin therapy was 49%, OR 0.51 (95% CI, 0.36 to 0.71). This reduction was observable in most of the subgroups of patients. CONCLUSIONS: The results of this nonrandomized study show that statin therapy improves survival after coronary artery stenting independent of patient characteristics recorded on the day of the intervention.     

Mortality associated with stopping statins in the oldest-old – with and without ischemic heart disease

The association between stopping statins and 1-year mortality in the general population of the oldest-old – with or without ischemic heart disease (IHD) – has been studied herein for the first time.This was a retrospective study. Included were all consecutive patients (n = 369) aged 80 years or more (mean age 87.8 years) hospitalized in a single Geriatrics department during 1 year. The study group included 140 patients in whom statins were stopped upon admission (statin stoppers). The control group included 229 patients who did not use statins in the first place (statin non-users). All-cause 1-year mortality rates were studied in both groups following propensity score matching and in IHD patients separately.Overall, 110 (29.8%) patients died during the year following admission: 38 (27.1%) statin stoppers and 72 (31.4%) statin non-users (P = .498). Cox regression analysis showed no association between stopping statins and 1-year mortality in the crude analysis (hazard ratio [HR] 0.976, 95% confidence interval [CI] 0.651–1.463, P = .907) and following propensity score matching (HR 1.067, 95%CI 0.674–1.689, P = .782). Among 108 IHD patients, 38 (35.2%) patients died during the year following admission: 18 (27.7%) statin stoppers and 20 (46.5%) statin non-users (P = .059). Cox regression analysis showed a nearly significant association between stopping statins (rather than not using statins) in IHD patients and lower 1-year mortality (HR 0.524, 95%CI 0.259–1.060, P = .072).Hence, stopping statins in the general population of the oldest-old – with or without IHD – is possibly safe. Future studies including the oldest-old statin continuers are warranted to confirm this observation.     

Statins use and the prognosis of colorectal cancer: a meta-analysis

BackgroundPrevious observational studies regarding the prognostic value of statin on colorectal cancer (CRC) patients showed various results.MethodsArticles regarding the prognostic value of statin on CRC and published in English and before October 2020 were searched in the following databases: PubMed, Web of Science, EMBASE, Medline and Google Scholar. The multivariate hazard ratios (HRs) and their 95% confidence intervals (CI) were computed to explore associations between statins use and overall mortality or cancer-specific mortality of CRC.ResultsThe study included 5 retrospective case-control studies (including 475 statins users and 1925 no-statin users) and 11 prospective cohort studies (including 40659 statins users and 344459 no-statin users). The present study showed that statins use might be significantly associated with lower overall mortality in CRC with a random effects model (HR = 0.81, 95% CI 0.76 to 0.86, I² = 61.9%, p value for Q test <0.001). In addition, statins use might be significantly associated with lower cancer-specific mortality in CRC with a random effects model (HR = 0.78, 95% CI 0.72 to 0.85, I² = 57.3%, p value for Q test = 0.007).ConclusionsIn conclusion, the present study indicated that that statin use was a protective factor for CRC prognosis. However, the relationship between statins use and CRC prognosis requires repeated and large prospective studies to be verified.