Importance Data are limited regarding statin therapy for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in adults 75 years and older. Objective To evaluate the role of statin use for mortality and primary prevention of ASCVD in veterans 75 years and older. Design, Setting, and Participants Retrospective cohort study that used Veterans Health Administration (VHA) data on adults 75 years and older, free of ASCVD, and with a clinical visit in 2002-2012. Follow-up continued through December 31, 2016. All data were linked to Medicare and Medicaid claims and pharmaceutical data. A new-user design was used, excluding those with any prior statin use. Cox proportional hazards models were fit to evaluate the association of statin use with outcomes. Analyses were conducted using propensity score overlap weighting to balance baseline characteristics. Exposures Any new statin prescription. Main Outcomes and Measures The primary outcomes were all-cause and cardiovascular mortality. Secondary outcomes included a composite of ASCVD events (myocardial infarction, ischemic stroke, and revascularization with coronary artery bypass graft surgery or percutaneous coronary intervention). Results Of 326 981 eligible veterans (mean [SD] age, 81.1 [4.1] years; 97% men; 91% white), 57 178 (17.5%) newly initiated statins during the study period. During a mean follow-up of 6.8 (SD, 3.9) years, a total 206 902 deaths occurred including 53 296 cardiovascular deaths, with 78.7 and 98.2 total deaths/1000 person-years among statin users and nonusers, respectively (weighted incidence rate difference [IRD]/1000 person-years, -19.5 [95% CI, -20.4 to -18.5]). There were 22.6 and 25.7 cardiovascular deaths per 1000 person-years among statin users and nonusers, respectively (weighted IRD/1000 person-years, -3.1 [95 CI, -3.6 to -2.6]). For the composite ASCVD outcome there were 123 379 events, with 66.3 and 70.4 events/1000 person-years among statin users and nonusers, respectively (weighted IRD/1000 person-years, -4.1 [95% CI, -5.1 to -3.0]). After propensity score overlap weighting was applied, the hazard ratio was 0.75 (95% CI, 0.74-0.76) for all-cause mortality, 0.80 (95% CI, 0.78-0.81) for cardiovascular mortality, and 0.92 (95% CI, 0.91-0.94) for a composite of ASCVD events when comparing statin users with nonusers. Conclusions and Relevance Among US veterans 75 years and older and free of ASCVD at baseline, new statin use was significantly associated with a lower risk of all-cause and cardiovascular mortality. Further research, including from randomized clinical trials, is needed to more definitively determine the role of statin therapy in older adults for primary prevention of ASCVD.

中文翻译：

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他汀类药物使用与 75 岁及以上美国退伍军人全因死亡率和心血管死亡率的关联

75 岁及以上成人动脉粥样硬化性心血管疾病 (ASCVD) 一级预防的他汀类药物治疗的重要性数据有限。目的 评估他汀类药物对 75 岁及以上退伍军人死亡率和 ASCVD 一级预防的作用。设计、设置和参与者 回顾性队列研究使用退伍军人健康管理局 (VHA) 的 75 岁及以上成年人的数据，无 ASCVD，并在 2002-2012 年进行了临床访问。随访一直持续到 2016 年 12 月 31 日。所有数据都与医疗保险和医疗补助索赔以及药品数据相关联。使用了新用户设计，不包括之前使用过他汀类药物的用户。Cox 比例风险模型适用于评估他汀类药物使用与结果的关联。使用倾向得分重叠加权进行分析以平衡基线特征。暴露任何新的他汀类药物处方。主要结果和措施 主要结果是全因死亡率和心血管死亡率。次要结局包括 ASCVD 事件（心肌梗塞、缺血性卒中和冠状动脉旁路移植术或经皮冠状动脉介入术的血运重建）的复合事件。结果 在 326 981 名符合条件的退伍军人（平均 [SD] 年龄，81.1 [4.1] 岁；97% 男性；91% 白人）中，有 57 178 (17.5%) 名在研究期间新开始使用他汀类药物。在平均 6.8 (SD, 3.9) 年的随访期间，总共发生了 206 902 例死亡，其中包括 53 296 例心血管死亡，他汀类药物使用者和非使用者的总死亡人数分别为 78.7 和 98.2 人/1000 人年，分别（加权发病率差异 [IRD]/1000 人年，-19.5 [95% CI，-20.4 至 -18.5]）。在他汀类药物使用者和非使用者中，每 1000 人年分别有 22.6 和 25.7 人死于心血管疾病（加权 IRD/1000 人年，-3.1 [95 CI，-3.6 至 -2.6]）。对于复合 ASCVD 结局，他汀类药物使用者和非使用者分别发生 123 379 次事件，分别为 66.3 和 70.4 次事件/1000 人年（加权 IRD/1000 人年，-4.1 [95% CI，-5.1 至 -3.0] ）。应用倾向评分重叠加权后，全因死亡率的风险比为 0.75（95% CI，0.74-0.76），心血管死亡率的风险比为 0.80（95% CI，0.78-0.81）和 0.92（95% CI，0.91） -0.94) 用于比较他汀类药物使用者和非使用者时的 ASCVD 事件复合。结论和相关性 在 75 岁及以上且基线时没有 ASCVD 的美国退伍军人中，新他汀类药物的使用与较低的全因死亡率和心血管死亡率风险显着相关。需要进一步的研究，包括来自随机临床试验的研究，以更明确地确定他汀类药物治疗在老年人 ASCVD 一级预防中的作用。