The Safety and Tolerability of Statin Therapy in Primary Prevention in Older Adults

A Systematic Review and Meta-analysis

Zhen Zhou*, Loai Albarqouni, Andrea J Curtis, Monique Breslin, Mark Nelson

*Corresponding author for this work

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

PURPOSE: The use of statins in the primary prevention of cardiovascular disease (CVD) is increasing in older adults. Nonetheless, good clinical evidence for the safety and tolerability of statins in this population is limited.

OBJECTIVE: We aimed to evaluate the safety and tolerability of statins in older adults without overt CVD, focusing on statin-related muscle symptoms.

METHODS: Double-blinded randomised controlled trials (RCTs) of statins published before January 2012 were identified from a Cochrane review updated to 2012. Trials published between January 2012 and July 2018 were identified through the CENTRAL, MEDLINE and EMBASE databases. Eligible trials were limited to those including individuals aged ≥ 65 years without overt CVD, who were followed for at least 1 year. Trials had to have reported at least one of the outcomes of interest. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using random-effects models.

RESULTS: We identified 11 trials, including 18,192 participants (mean age 73.7 years; 43% females). Compared with placebo, statins neither increased the risks of muscle-related symptoms (RR 1.01; 95% CI 0.90-1.12), total adverse events (AEs) and serious AEs nor led to more total permanent treatment discontinuations and discontinuations due to AEs or specifically due to muscle-related symptoms. No evidence of heterogeneity was observed in any of these outcomes.

CONCLUSIONS: This meta-analysis of RCTs found no excess incidence of muscle-related symptoms, total AEs, serious AEs and treatment discontinuations attributable to statin treatment compared with placebo among older adults without CVD.

Original languageEnglish
JournalDrugs and Aging
DOIs
Publication statusE-pub ahead of print - 10 Jan 2020

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Primary Prevention
Meta-Analysis
Safety
Cardiovascular Diseases
Muscles
Therapeutics
Randomized Controlled Trials
Placebos
Confidence Intervals
MEDLINE
Databases
Incidence
Population

Cite this

@article{e20f66b08c5847ba8a54b80b210d9dc9,
title = "The Safety and Tolerability of Statin Therapy in Primary Prevention in Older Adults: A Systematic Review and Meta-analysis",
abstract = "PURPOSE: The use of statins in the primary prevention of cardiovascular disease (CVD) is increasing in older adults. Nonetheless, good clinical evidence for the safety and tolerability of statins in this population is limited.OBJECTIVE: We aimed to evaluate the safety and tolerability of statins in older adults without overt CVD, focusing on statin-related muscle symptoms.METHODS: Double-blinded randomised controlled trials (RCTs) of statins published before January 2012 were identified from a Cochrane review updated to 2012. Trials published between January 2012 and July 2018 were identified through the CENTRAL, MEDLINE and EMBASE databases. Eligible trials were limited to those including individuals aged ≥ 65 years without overt CVD, who were followed for at least 1 year. Trials had to have reported at least one of the outcomes of interest. Pooled relative risk (RR) estimates and 95{\%} confidence intervals (CIs) were calculated using random-effects models.RESULTS: We identified 11 trials, including 18,192 participants (mean age 73.7 years; 43{\%} females). Compared with placebo, statins neither increased the risks of muscle-related symptoms (RR 1.01; 95{\%} CI 0.90-1.12), total adverse events (AEs) and serious AEs nor led to more total permanent treatment discontinuations and discontinuations due to AEs or specifically due to muscle-related symptoms. No evidence of heterogeneity was observed in any of these outcomes.CONCLUSIONS: This meta-analysis of RCTs found no excess incidence of muscle-related symptoms, total AEs, serious AEs and treatment discontinuations attributable to statin treatment compared with placebo among older adults without CVD.",
author = "Zhen Zhou and Loai Albarqouni and Curtis, {Andrea J} and Monique Breslin and Mark Nelson",
year = "2020",
month = "1",
day = "10",
doi = "10.1007/s40266-019-00736-y",
language = "English",
journal = "Drugs and Aging",
issn = "1170-229X",
publisher = "Adis International Ltd",

}

The Safety and Tolerability of Statin Therapy in Primary Prevention in Older Adults : A Systematic Review and Meta-analysis. / Zhou, Zhen; Albarqouni, Loai; Curtis, Andrea J; Breslin, Monique; Nelson, Mark.

In: Drugs and Aging, 10.01.2020.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - The Safety and Tolerability of Statin Therapy in Primary Prevention in Older Adults

T2 - A Systematic Review and Meta-analysis

AU - Zhou, Zhen

AU - Albarqouni, Loai

AU - Curtis, Andrea J

AU - Breslin, Monique

AU - Nelson, Mark

PY - 2020/1/10

Y1 - 2020/1/10

N2 - PURPOSE: The use of statins in the primary prevention of cardiovascular disease (CVD) is increasing in older adults. Nonetheless, good clinical evidence for the safety and tolerability of statins in this population is limited.OBJECTIVE: We aimed to evaluate the safety and tolerability of statins in older adults without overt CVD, focusing on statin-related muscle symptoms.METHODS: Double-blinded randomised controlled trials (RCTs) of statins published before January 2012 were identified from a Cochrane review updated to 2012. Trials published between January 2012 and July 2018 were identified through the CENTRAL, MEDLINE and EMBASE databases. Eligible trials were limited to those including individuals aged ≥ 65 years without overt CVD, who were followed for at least 1 year. Trials had to have reported at least one of the outcomes of interest. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using random-effects models.RESULTS: We identified 11 trials, including 18,192 participants (mean age 73.7 years; 43% females). Compared with placebo, statins neither increased the risks of muscle-related symptoms (RR 1.01; 95% CI 0.90-1.12), total adverse events (AEs) and serious AEs nor led to more total permanent treatment discontinuations and discontinuations due to AEs or specifically due to muscle-related symptoms. No evidence of heterogeneity was observed in any of these outcomes.CONCLUSIONS: This meta-analysis of RCTs found no excess incidence of muscle-related symptoms, total AEs, serious AEs and treatment discontinuations attributable to statin treatment compared with placebo among older adults without CVD.

AB - PURPOSE: The use of statins in the primary prevention of cardiovascular disease (CVD) is increasing in older adults. Nonetheless, good clinical evidence for the safety and tolerability of statins in this population is limited.OBJECTIVE: We aimed to evaluate the safety and tolerability of statins in older adults without overt CVD, focusing on statin-related muscle symptoms.METHODS: Double-blinded randomised controlled trials (RCTs) of statins published before January 2012 were identified from a Cochrane review updated to 2012. Trials published between January 2012 and July 2018 were identified through the CENTRAL, MEDLINE and EMBASE databases. Eligible trials were limited to those including individuals aged ≥ 65 years without overt CVD, who were followed for at least 1 year. Trials had to have reported at least one of the outcomes of interest. Pooled relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using random-effects models.RESULTS: We identified 11 trials, including 18,192 participants (mean age 73.7 years; 43% females). Compared with placebo, statins neither increased the risks of muscle-related symptoms (RR 1.01; 95% CI 0.90-1.12), total adverse events (AEs) and serious AEs nor led to more total permanent treatment discontinuations and discontinuations due to AEs or specifically due to muscle-related symptoms. No evidence of heterogeneity was observed in any of these outcomes.CONCLUSIONS: This meta-analysis of RCTs found no excess incidence of muscle-related symptoms, total AEs, serious AEs and treatment discontinuations attributable to statin treatment compared with placebo among older adults without CVD.

U2 - 10.1007/s40266-019-00736-y

DO - 10.1007/s40266-019-00736-y

M3 - Review article

JO - Drugs and Aging

JF - Drugs and Aging

SN - 1170-229X

ER -