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Open Access Research article

The impact of statins on health services utilization and mortality in older adults discharged from hospital with ischemic heart disease: a cohort study

Charmaine A Cooke*, Susan A Kirkland, Ingrid S Sketris and Jafna Cox

BMC Health Services Research 2009, 9:198  doi:10.1186/1472-6963-9-198

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Statins in the over 65 year olds are malpractice.

eddie vos   (2009-12-31 14:13)  health-heart.org email

In this mean age 77.5 Nova Scotian population, the authors suggest a 26% reduced mortality in those being prescribed a statin upon hospital discharge. Such prescriptions evidently select the higher cholesterol group, UN-selecting those in the lowest quartile for cholesterol. It is in that low-cholesterol group that we always find the highest mortality rate in a general population over age 50, most elegantly shown in the massive Vorarlberg Study(1).

Moreover, the authors misrepresent the PROSPER study in their ref. #10, suggesting statin provided a mortality benefit in a group of mean 75.4 year olds at baseline. In fact, the mortality vs placebo was identical +/- 0.1%.

Finally, we know from 2 meta-analysis that statins do not extend female lives or prevent second heart attacks in women [ref's in (2)] and we know from all atorvastatin [Lipitor] studies ever published that there has never been a mortality benefit vs placebo - and I would argue the same for just about any statin [ref's in "Statins for Women, Elderly: Malpractice?(3) Statins lose whatever non-fatal cardiac 'event' effects in the elder, as they do in those with heart failure i.e., again, the elder.

Interestingly, the authors find no benefit in subsequent cardiac outcomes in their elder population as measured by health services utilization. Such lack of cardiac outcomes in those over age 65 was also found in the statin comparison study IDEAL for top dose atorvastatin vs low dose simvastatin, and vs those under age 65.

IN SUMMARY, statins as a rule should not be prescribed in the over age 65 population as studied which is something strongly supported by this observational study(4).

1. Vorarlberg Study
2. CMAJ
3. Statins for Women, Elderly: Malpractice?
4. general cholesterol comments by author

Competing interests

None

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