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The association between statin use and outcomes potentially attributable to an unhealthy lifestyle in older adults.

ABSTRACT: OBJECTIVE:To explore the "healthy user" and "healthy adherer" effects-hypothetical sources of bias thought to arise when patients who initiate and adhere to preventive therapies are more likely to engage in healthy behaviors than are other subjects. METHODS:The authors examined the association between statin initiation and adherence, and the subsequent use of preventive health services and incidence of clinical outcomes unlikely to be associated with the need for, or use of, a statin among older enrollees in two state-sponsored drug benefit programs. RESULTS:After adjustment for demographic and clinical covariates, patients who initiated statin use were more likely to receive recommended preventive services than noninitiators matched on age, sex, and state (hazard ratio [HR]: 1.10, 1.06-1.14 for males, HR: 1.09, 1.07-1.11 for females) and appeared to have a lower risk of a range of adverse outcomes (HR: 0.87, 0.85-0.89) thought to be unrelated to statin use. Adherence to a statin regimen was also associated with increased rates of preventive service use and a decreased rate of adverse clinical outcomes (HR: 0.93, 0.88-0.99). CONCLUSIONS:These results suggest that patients initiating and adhering to chronic preventive drug therapies are more likely to engage in other health-promoting behaviors. Failure to account for this relationship may introduce bias in any epidemiologic study evaluating the effect of a preventive therapy on clinical outcomes.

SUBMITTER: Patrick AR

PROVIDER: S-EPMC5059150 | biostudies-literature | 2011 Jun

REPOSITORIES: biostudies-literature

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The association between statin use and outcomes potentially attributable to an unhealthy lifestyle in older adults.

Patrick Amanda R AR Shrank William H WH Glynn Robert J RJ Solomon Daniel H DH Dormuth Colin R CR Avorn Jerry J Cadarette Suzanne M SM Mogun Helen H Brookhart M Alan MA

Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research 20110422 4

<h4>Objective</h4>To explore the "healthy user" and "healthy adherer" effects-hypothetical sources of bias thought to arise when patients who initiate and adhere to preventive therapies are more likely to engage in healthy behaviors than are other subjects.<h4>Methods</h4>The authors examined the association between statin initiation and adherence, and the subsequent use of preventive health services and incidence of clinical outcomes unlikely to be associated with the need for, or use of, a sta ...[more]

PMID: 21669377

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Project description:ObjectiveThe aim of this analysis was to investigate the relationship of statins with institutionalisation and death in older men living in the community, accounting for frailty.DesignProspective cohort study.SettingCommunity-dwelling men participating in the Concord Health and Ageing in Men Project, Sydney, Australia.ParticipantsMen aged ?70 years (n=1665).MeasurementsData collected during baseline assessments and follow-up (maximum of 6.79 years) were obtained. Information regarding statin use was captured at baseline, between 2005 and 2007. Proportional hazards regression analysis was conducted to estimate the risk of institutionalisation and death according to statin use (exposure, duration and dose) and frailty status, with adjustment for sociodemographics, medical diagnosis and other clinically relevant factors. A secondary analysis used propensity score matching to replicate covariate adjustment in regression models.ResultsAt baseline, 43% of participants reported taking statins. Over 6.79 years of follow-up, 132 (7.9%) participants were institutionalised and 358 (21.5%) participants had died. In the adjusted models, baseline statin use was not statistically associated with increased risk of institutionalisation (HR=1.60; 95% CI 0.98 to 2.63) or death (HR=0.88; 95% CI 0.66 to 1.18). There was no significant association between duration and dose of statins used with either outcome. Propensity scoring yielded similar findings. Compared with non-frail participants not prescribed statins, the adjusted HR for institutionalisation for non-frail participants prescribed statins was 1.43 (95% CI 0.81 to 2.51); for frail participants not prescribed statins, it was 2.07 (95% CI 1.11 to 3.86) and for frail participants prescribed statins, it was 4.34 (95% CI 2.02 to 9.33).ConclusionsThese data suggest a lack of significant association between statin use and institutionalisation or death in older men. These findings call for real-world trials specifically designed for frail older people to examine the impact of statins on clinical outcomes.

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The association between statin use and outcomes potentially attributable to an unhealthy lifestyle in older adults.

Publications

The association between statin use and outcomes potentially attributable to an unhealthy lifestyle in older adults.

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