| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|---|
|
|
|
|||||||
|
|||||||||
125 mg/dl Treated With Statins
a Cardiology Division, Department of Medicine,Westchester Medical Center/New York Medical College, Valhalla
b Department of Medicine, University of Texas Medical School at Houston
c Neurocare Associates, Bronx, New York
Wilbert S. Aronow, Cardiology Division, New York Medical College, 23 Pebble Way, New Rochelle, NY 10804 E-mail: WSAronow{at}aol.com.
 |
Abstract |
|---|
 Top Abstract MethodsResultsDiscussionReferences |
|---|
125 mg/dl treated with statins and with no lipid-lowering drug.
Methods. The incidence of new coronary events and of new ABI was investigated in an observational prospective study of 529 diabetics, mean age 79 ± 9 years, with prior myocardial infarction and a serum LDL cholesterol of 125 mg/dl treated with statins (279 persons or 53%) and no lipid-lowering drug (250 persons or 47%). Follow-up was 29 ± 18 months.
Results. At follow-up, the stepwise Cox regression model showed that after controlling for other risk factors, the use of statins was associated with a 37% significant independent reduction in the incidence of new coronary events and with a 47% significant independent reduction in the incidence of new ABI.
Conclusions. Use of statins was associated with a 37% significant, independent reduction in new coronary events and a 47% significant, independent reduction in new ABI in older men and women with diabetes mellitus, prior myocardial infarction, and a serum LDL cholesterol of 125 mg/dl. Elderly diabetics with prior myocardial infarction and increased serum LDL cholesterol should especially be treated with statins.
OLDER persons with coronary artery disease and hypercholesterolemia or increased serum low-density lipoprotein (LDL) cholesterol treated with statins had a reduction in the incidence of new coronary events (1)(2)(3)(4)(5)(6) and in the incidence of new stroke (1)(2)(3)(5)(6)(7). Numerous studies have shown that diabetes mellitus is a risk factor for new coronary events (8)(9)(10)(11)(12) and for new stroke in older persons (11)(12)(13)(14).
To the best of our knowledge, data on the effect of statins on the incidences of new coronary events and of new atherothrombotic brain infarction (ABI) in persons older than 75 years of age with diabetes mellitus, prior myocardial infarction, and a serum LDL cholesterol 125 mg/dl have not been previously reported. A serum LDL cholesterol 125 mg/dl was an arbitrary value selected at the onset of the study. Therefore, we performed a prospective observational study investigating the effect of statins on the incidences of new coronary events and of new ABI in older persons 62 to 100 years of age with diabetes mellitus, prior myocardial infarction, and a serum LDL cholesterol 125 mg/dl followed prospectively for the incidences of new coronary events and of new ABI. This article reports the data from this very elderly population.
|
Methods |
|---|
|
TopAbstractMethodsResultsDiscussionReferences |
|---|
125 mg/dl treated with a statin or with no lipid-lowering drug were followed prospectively in a long-term health care facility for the incidences of new coronary events and new ABI. The 559 persons in this study were unselected persons 62 to 100 years of age who were not terminally ill at admission to the long-term health care facility. No other exclusion criteria were used. All study subjects were enrolled on admission to the long-term health care facility and were entered into a database. A chart review was done periodically on all patients for the purposes of this study. All persons were followed by their full-time staff physicians who immediately reported all suspected coronary events to a cardiologist (W.S. Aronow) and all suspected strokes to a neurologist (H. Gutstein). All coronary events were confirmed by the cardiologist (W.S. Aronow), and all strokes were confirmed by the neurologist (H. Gutstein). Follow-up time was until the time of a new coronary event, a new ABI, death, or cutoff date for analysis of the data. Persons were considered to have prior myocardial infarction if they had a documented clinical history of myocardial infarction or electrocardiographic evidence of Q-wave myocardial infarction. New coronary events were diagnosed if the person developed nonfatal or fatal myocardial infarction (15) or sudden coronary death (16) as previously described.
Prior ABI and new ABI were diagnosed by a neurologist as previously described (14). The focal neurological signs of ischemic stroke were explained by loss of function in a restricted area of the brain corresponding to a particular vascular territory (14). New ABI was also confirmed by computerized axial tomography in 154 of 157 persons (98%).
Diabetes mellitus was diagnosed according to the American Diabetes Association's new criteria (17). Fasting plasma glucose testing was performed in all persons in the study. Of the 529 persons with diabetes mellitus, 464 persons (88%) were treated with insulin or oral hypoglycemic drugs, and 65 persons (12%) were treated with diet alone. Systemic hypertension was diagnosed according to the criteria of the Sixth Joint National Committee Report on the Detection, Evaluation, and Treatment of Hypertension (18). Fasting serum lipids were drawn in all persons after a 12- to 14-hour overnight fast at baseline, after 1 month of therapy, and every 6 months during the study. A serum LDL cholesterol of 125 mg/dl was considered increased. A person was considered obese if the body mass index exceeded 30 kg/m2.
In this study, the full-time staff physicians taking care of the persons treated 279 of 529 diabetics (53%) with a statin and 250 of 529 diabetics (47%) with no lipid-lowering drug. The attitude of different physicians toward treating hypercholesterolemia in older persons with prior myocardial infarction determined whether or not statins were prescribed. Follow-up was 29 ± 18 months (range 2 to 133 months).
Chi-square tests were used to analyze dichotomous variables and Student's t tests for continuous variables (Table 1 Table 2 Table 3 ). The Cox regression model was used to identify significant independent prognostic factors for the time to the development of new coronary events (Table 4 ) and for the time to the development of new ABI (Table 5 ). All of the variables listed in Table 1 were included in the stepwise Cox regression model.
|
|
|
|
|
|
Results |
|---|
|
TopAbstractMethodsResultsDiscussionReferences |
|---|
Table 2 shows the initial and last serum lipids in the diabetics treated with statins versus no lipid-lowering drug and lists levels of statistical significance. Baseline and follow-up serum lipids were not significantly different in persons treated with no lipid-lowering drug. Statins reduced serum LDL cholesterol by 34%, increased serum HDL cholesterol by 8%, and reduced serum triglycerides by 11%. Fasting plasma glucose levels and hemoglobin A1c levels were not significantly different between diabetics treated with statins versus no lipid-lowering drug.
Table 3 shows the incidences of new coronary events and of new ABI in the diabetics treated with statins versus no lipid-lowering drug and lists levels of statistical significance. Univariate analysis showed that statins reduced the incidence of new coronary events by 21% and of new ABI by 29%.
Table 4 shows the prognostic variables for new coronary events and their regression coefficients in the stepwise Cox regression model. Significant independent risk factors for new coronary events were age (risk ratio = 1.03 for each 1-year increase in age), cigarette smoking (risk ratio = 1.8), systemic hypertension (risk ratio = 1.5), initial serum LDL cholesterol (risk ratio = 1.01 for each 1 mg/dl increase), initial serum HDL cholesterol (risk ratio = 0.96 for each 1 mg/dl increase), and use of statins (risk ratio = 0.63).
Table 5 shows the prognostic variables for new ABI and their regression coefficients in the stepwise Cox regression model. Significant independent risk factors for new ABI were age (risk ratio = 1.03 for each 1-year increase in age), cigarette smoking (risk ratio = 3.4), systemic hypertension (risk ratio = 2.3), initial serum LDL cholesterol (risk ratio = 1.01 for each 1 mg/dl increase), initial serum HDL cholesterol (risk ratio = 0.97 for each 1 mg/dl increase), body mass index >30 kg/m2 (risk ratio = 1.5), prior stroke (risk ratio = 2.1), and use of statins (risk ratio = 0.53).
|
Discussion |
|---|
|
TopAbstractMethodsResultsDiscussionReferences |
|---|
125 mg/dl, the use of statins was associated with a reduction in the incidence of new coronary events and with a reduction in the incidence of new ABI. The major limitation of this study is that it was not a randomized, double-blind, placebo-controlled study. However, this is a large prospective observational study investigating the effect of statins on the incidence of new coronary events and of new ABI in a very elderly population of diabetics with prior myocardial infarction and a serum LDL cholesterol level of 125 mg/dl or higher. Except for a 1 mg/dl decrease in baseline serum HDL cholesterol in persons treated with no lipid-lowering drug, there were no significant differences in baseline characteristics between persons treated with statins versus no lipid-lowering drug.
Whereas no data have previously been published in diabetics older than 75 years of age with prior myocardial infarction treated with statins, the mean age of our study population was 79 years, with persons up to 100 years of age included in the study. The study population was followed very closely by their full-time staff physicians with all suspected coronary events immediately reported to a cardiologist and all suspected strokes immediately reported to a neurologist. All coronary events were confirmed by a cardiologist, and all ABIs were confirmed by a neurologist. New ABI was also confirmed by computerized axial tomography in 98% of new ABIs.
All data were analyzed by a biostatistician. A stepwise Cox regression model including all variables listed in Table 1 was used to determine significant independent predictors of new coronary events and significant independent predictors of new ABI. The reduction in incidence of new coronary events and new ABI associated with statin use was determined after controlling for the other risk factors listed in Table 1 .
We can conclude from our data that use of statins in this very elderly study population was associated with a 37% significant independent reduction in the incidence of new coronary events and with a 47% significant independent reduction in the incidence of new ABI. However, a double-blind, randomized, placebo-controlled study in a very elderly population of diabetics with prior myocardial infarction and an elevated serum LDL cholesterol is needed to confirm our data. The extremely high incidence of new coronary events and of new ABI in this population increases the importance of assessing possible interventions.
The absolute reduction in coronary events and stroke associated with use of statins has been found to be greater in elderly persons than in younger persons in the Scandinavian Simvastatin Survival Study, in the Cholesterol and Recurrent Events Trial, and in the Long-Term Intervention With Pravastatin in Ischaemic Disease study (5)(6). Therefore, elderly persons with coronary artery disease, other atherosclerotic vascular disease, and diabetes mellitus with increased serum LDL cholesterol levels should be treated with statins.
Received April 29, 2002
Accepted June 17, 2002
|
References |
|---|
|
TopAbstractMethodsResultsDiscussionReferences |
|---|
125 mg/dL treated with statins versus no lipid-lowering drug. Am J Cardiol. 89:67-69. [Medline]
125 mg/dL treated with statins versus no lipid-lowering drug. J Gerontol Med Sci. 57A:M333-M335. This article has been cited by other articles:
|
|
 |
|
  W. S. Aronow Drug Treatment of Systolic and of Diastolic Heart Failure in Elderly Persons J. Gerontol. A Biol. Sci. Med. Sci., December 1, 2005; 60(12): 1597 - 1605. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Sanal and W. S. Aronow Effect of an Educational Program on the Prevalence of Use of Antiplatelet Drugs, Beta Blockers, Angiotensin-Converting Enzyme Inhibitors, Lipid-Lowering Drugs, and Calcium Channel Blockers Prescribed During Hospitalization and at Hospital Discharge in Patients With Coronary Artery Disease J. Gerontol. A Biol. Sci. Med. Sci., November 1, 2003; 58(11): M1046 - 1048. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Suryadevara, S. G. Storey, W. S. Aronow, and C. Ahn Association of Abnormal Serum Lipids in Elderly Persons With Atherosclerotic Vascular Disease and Dementia, Atherosclerotic Vascular Disease Without Dementia, Dementia Without Atherosclerotic Vascular Disease, and No Dementia or Atherosclerotic Vascular Disease J. Gerontol. A Biol. Sci. Med. Sci., September 1, 2003; 58(9): M859 - 861. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Ghosh and W. S. Aronow Utilization of Lipid-Lowering Drugs in Elderly Persons With Increased Serum Low-Density Lipoprotein Cholesterol Associated With Coronary Artery Disease, Symptomatic Peripheral Arterial Disease, Prior Stroke, or Diabetes Mellitus Before and After an Educational Program on Dyslipidemia Treatment J. Gerontol. A Biol. Sci. Med. Sci., May 1, 2003; 58(5): M432 - 435. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|---|
| All GSA journals | The Gerontologist |
| Journals of Gerontology Series B: Psychological Sciences and Social Sciences | |
