Statins are highly effective cholesterol-lowering medications used for primary prevention of cardiovascular disease (CVD) and are one of the most commonly prescribed medications. However, data on safety and efficacy of statins for primary prevention of CVD in adults over 75 years is scarce and as a result, the 2013 American College of Cardiology/American Heart Association cholesterol guidelines do not support routine use of statins for primary prevention after age 75. Current VA guidelines do not address the issue of age and recommend that all Veterans at moderate risk of CVD should be prescribed at least a moderate intensity statin, including the 4.5 million veterans who are over 75 years. Furthermore, the risk of CVD rises with age and is closely linked to frailty, a multidimensional state of vulnerability that is associated with an increased risk of disease, disability, death, and healthcare costs. Those who are frail are at increased risk of incident CVD while those with CVD are at increased risk of de novo frailty. CVD and frailty share common biologic pathways and risk factors, such as inflammation, raising the possibility that statins may prevent or slow time to frailty. However, whether statins can prevent frailty is unknown. As Veterans age, identifying preventive strategies for common conditions such as CVD and frailty is critical. Therefore, the research activities in this career development award will use a retrospective design to test the hypotheses that (1) statins, taken for primary prevention, are associated with a lower risk of major cardiovascular events (fatal and non-fatal myocardial infarction, acute coronary syndrome, coronary revascularization, and stroke) and mortality in veterans ?75 years and (2) statin use is associated with a lower risk of frailty over a minimum 10 years of follow up in Veterans ?65. We will also examine the role of statin intensity for both the primary prevention of CVD and frailty. Our secondary aims will test the hypotheses that statin use is associated with (i) a non-significant risk of cognitive decline, and myalgias and (ii) a faster gait speed ? a surrogate of frailty ? among older veterans. This work will inform the design of future clinical trials of statins for prevention of CVD in adults over 75 years and prevention of frailty. In addition to the pharmacoepidemiologic study proposed, this career development award includes mentorship, coursework, and seminars in advanced epidemiologic and statistical methods, geriatrics, and cardiology. The research and career development activities will prepare the applicant for her long-term goal of a research career in geriatric preventive cardiology and will inform Veteran preventive care, health, and aging.

Public Health Relevance

As the Veteran population ages, identifying preventive strategies for heart disease, stroke, and frailty is a priority. Heart attack, stroke, and frailty are common in older adults and may all be caused by inflammation. Statins are medications that lower cholesterol, decrease inflammation and have been proven to lower the risk of heart attack and stroke. As a result, statins are used by millions of Veterans every year, but it remains unclear whether statins are beneficial for adults over 75 years for prevention of heart attack, stroke, or frailty. This project will examine whether statins taken by Veterans over 75 years are useful in lowering the risk of a first heart attack or stroke, and whether statins taken over 15 years can lower the risk of becoming frail in older Veterans.

National Institute of Health (NIH)
Veterans Affairs (VA)
Veterans Administration (IK2)
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Special Emphasis Panel (ZRD1)
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VA Boston Health Care System
United States
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