Many more elderly people could benefit from drugs to prevent heart disease

Preventive treatments for cardiovascular disease may be underutilized in older patients. Although age and gender inequalities are known to exist for secondary prevention of cardiovascular disease, whether this pertains to interventions focused toward preventing heart disease is less clear.

To establish whether age and sex deter physicians from assigning primary preventive treatment for cardiovascular disease in a primary care population, researchers conducted a cross-sectional study of all 41,250 patient records of patients ages 40 and older at 19 general practices in the West Midlands, United Kingdom.

Patients were subdivided into five-year age brackets up to 85 years old, and researchers assessed prescribing trends across the population by estimating the proportion of patients prescribed an antihypertensive drug or statin, or both, in each group. Results were published online July 12 by BMJ.

The proportion of patients receiving antihypertensive drugs increased with age, from 5% of those ages 40 to 44 to 57% of those older than 85. The likelihood of prescription of an antihypertensive drug increased with each five-year age increment, with patients ages 45 to 49 having an odds ratio (OR) of receiving an antihypertensive of 1.8 (95% CI, 1.6 to 2.0; P<0.001) and patients ages 80 to 84 having an OR of 25.8 (95% CI, 22.2 to 30.1; P<0.001) compared to a reference standard of 40- to 44-year-olds.

Use of statin drugs also increased with age up to 74, from 3% of patients ages 40 to 44 to 29% of 70- to 74-year-olds. In those age 75 and over, however, only 23% were prescribed statins. In those age 75 and older, the odds of receiving a statin prescription decreased with every five-year bracket from ages 75 to 79 (OR compared to ages 40 to 44, 12.9; 95% CI, 10.8 to 15.3; P<0.001) to age 85 and older (OR, 5.7; 95% CI, 4.6 to 7.2; P<0.001).

The proportion of men and women prescribed antihypertensive drugs was similar in all age groups apart from those ages 65 to 69 and 75 to 79, in whom prescriptions were more common for women (39% of women compared to 34% of men for ages 65 to 69; 55% to 48%, respectively, for ages 75 to 79). Overall, women were 10% more likely to receive antihypertensive drugs than men (P<0.001).

Statin prescriptions were more common in men than women below age 60 (6% in women compared to 8% in men, for ages 40 to 59) but were more common in women over age 75 (28% in women compared to 22% in men, for ages 75 to 84). Overall, men were more likely to receive statin prescriptions than women (OR, 1.1; 95% CI, 1.1 to 1.2; P<0.001).

The authors wrote, “[T]here is a striking contrast between use of statins and use of antihypertensive drugs in older people, which does point to possible underuse of statins. To better understand the clinical implications of our findings, more research is needed to determine why general practitioners refrain from prescribing primary preventive treatment in elderly people, the attitudes of older people towards preventive drugs, and the costs and benefits of prescribing in this age group.”