Statine,Prophylaxe Herz-Kreislaufleiden, Newsletter Kardiologie aktuell

Die Vorteile einer Therapie mit Blutfettsenkern aus der Gruppe der Statine überwiegen dem Anschein nach die beobachteten Nachteile:

Die gemeinsame Analyse von neun nach strengen Kriterien ausgewerteten wissenschaftlichen Studien belegt, dass die zur Gruppe der Statine gehörenden Blutfettsenker bei älteren Menschen offenbar in der Lage sind , das allgemeine Sterberisiko um rund ein Viertel zu senken. Dieser nicht zu unterschätzende Vorteil überwiegt nach Meinung der Autoren die auch vorhandenen Nachteile einer Statin-Therapie. Um ein Menschenleben zu retten, müssen laut Studie 28 ältere Menschen mit einem Statin behandelt werden.

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Die vollständige englischsprachige Kurzversion dieser Studie
(den sog. MEDLINE Abstract) finden Sie hier

Statins for Secondary Prevention in Elderly Patients: A Hierarchical Bayesian Meta-Analysis

1/1/2008

Afilalo J, Duque G, Steele R, Jukema JW, de Craen AJ, Eisenberg MJ.

J Am Coll Cardiol. 2008;51:37-45.

Study Question: Is statin use associated with reduced all-cause mortality among elderly patients with coronary heart disease (CHD)?

Methods: Pertinent trials were identified from literature searches of five electronic data sets, the Internet, and conference proceedings. Unpublished data were obtained from elderly subgroups of four trials and for the secondary prevention group of the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) trial. Inclusion criteria included the use of a randomized study design (statin vs. placebo), documented CHD, and 50 or more subjects ≥65 years of age and ≥6 months of follow-up. The primary outcome of interest was all-cause mortality, whereas secondary outcomes included CHD mortality, nonfatal myocardial infarction (MI), need for revascularization, and stroke.

Results: Nine trials fulfilled all criteria for inclusion. A total of 19,569 subjects (ages 65-92 years; mean weighted follow-up was 4.9 years) were included in this analysis. Pooled rates of all-cause mortality were 15.6% in the statin users and 18.7% for those randomized to placebo. The pooled 5-year relative risk (RR) for statin users was 0.78 (95% confidence interval [CI], 0.65-0.89) compared with placebo. For CHD mortality, the RR was 0.70 (95% CI, 0.53-0.83), whereas the RR for nonfatal MI was 0.74 (95% CI, 0.60-0.89), the RR for revascularization was 0.70 (95% CI, 0.58-0.83), and for stroke was 0.75 (95% CI, 0.56-0.94). The number needed to treat for one life saved was 28.

Conclusions: The authors concluded that statin use in elderly patients reduced all-cause mortality and that the absolute benefit appears to be significantly greater than has been observed in younger populations.

Perspective: The elderly are at high risk for secondary cardiovascular disease events and, as such, risk factor management is an important component of their care. However, health care providers often undertreat elderly patients based on the assumption that with fewer years ahead, there may be little benefit to such prevention efforts. This study suggests otherwise. Elizabeth A. Jackson, M.D., F.A.C.C.