Statin Treatment for Primary and Secondary Prevention in Elderly Patients in Region Stockholm

Background: Aging is a major risk factor for atherosclerotic cardiovascular diseases (CVD) and death. There is limited evidence on benefits of statin therapy for primary prevention in elderly patients, while there is strong evidence for its use in secondary prevention. The knowledge of prescribing patterns of statins to elderly is limited. Aim: To provide an overview of the use of statins in primary and secondary prevention for patients ≥ 75 years in Region Stockholm in 2019. Methods: A cross-sectional study based on the regional health database VAL containing all diagnoses and dispensed prescription drugs for all 174 950 inhabitants ≥ 75 years old in Region Stockholm. Prevalence and incidence were analysed by sex, age, cardiovascular risk, prescriber category, substance and the intensity of treatment. Results: Of the elderly population, 25-43% were treated with statins, and 2-4% were initiated on statins during 2019. Men, individuals <85 years and those with higher cardiovascular risk were treated to a higher extent. Simvastatin was prescribed primarily to prevalent users and atorvastatin to incident users. A majority were treated with moderate-intensity dosages and fewer women received high intensity treatment. General practitioners accounted for a majority of all prescriptions and they prescribed mainly low and moderate intensity dosages. Conclusions: Statins are widely prescribed in elderly. It is likely that there is undertreatment among high-risk patients (especially women and elderly 85+ years) and overtreatment among patients with low-risk for CVD. Physicians seem to consider patients’ cardiovascular risk when deciding to initiate statin treatment for elderly