Statin treatment in the ageing population

In Western countries, the number of people aged 80 years and older with cardiovascular disease will rise in the coming years. Statins have been shown to prevent cardiovascular disease in patients below 80 years. In patients above 80 evidence is limited, yet many older patients are being treated with statins. It can be hard to determine whether to initiate or discontinue statin treatment in older patients. A prevalent cardiovascular disease in older persons is aortic valve stenosis. Transcatheter aortic valve implantation (TAVI), a minimally invasive procedure, isa viable treatment for aortic valve stenosis in frail patients. It is however unclear if frailty parameters increase the complication risk post-TAVI and whether statin treatment decreases this risk. In this thesis, we found that initiating statins after 80 reduced the risk of new cardiovascular events when initiated after a first heart attack or stroke. Furthermore, we demonstrated that discontinuation of statin treatment increased the risk for new cardiovascular events. This increased risk was found both in fit and frail older patients. Additionally, we found that impaired cognition doubled the risk of complications post-TAVI, and that statin use did not lower this complication risk. Based on our research, we recommend initiating statin treatment above the age of 80 after a cardiovascular event and not to discontinue statin treatment thereafter, unless adverse effects occur or it no longer fits goals of care. Exploring cognitive function before TAVI is important, as impairment is associated with a higher complication risk. Initiation of statins before TAVI to reduce this risk is not recommended.