Jennifer G. Robinson, MD, MPH
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L15-0321.
Robinson J.; Statins for Primary Prevention in Adults Aged 75 Years or Older. Ann Intern Med. 2015;163:481. doi: 10.7326/L15-5135
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Published: Ann Intern Med. 2015;163(6):481.
TO THE EDITOR:
Odden and colleagues (1) did not include stroke in their estimate of the cost-effectiveness of statins for primary prevention in adults aged 75 years or older. This results in an underestimate of the benefits of statins in this age group and an overestimate of their costs. Stroke increases dramatically with advancing age and accounts for a large proportion of cardiovascular events in this population (2).
The amount by which statins reduce the risk for ischemic stroke is similar to that for coronary heart disease (CHD) (3). The costs of nonfatal strokes are high, including those for prolonged hospitalization and long-term care that are not present for CHD. In addition, the authors misrepresent the inclusiveness of their analysis by referring repeatedly to cardiovascular disease reduction and failing to mention the lack of the inclusion of stroke as a serious limitation. The term "cardiovascular disease" includes stroke as well as CHD (4).
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