SCORE2-OP-guided statin initiation for primary prevention in adults aged 70–89 years without diabetes: evidence for age-specific risk thresholds

Abstract Aims Current guidelines suggest a unique 10-year cardiovascular disease (CVD) risk threshold for the oldest to consider lipid-lowering treatment for CVD prevention. We aimed to assess the benefit of initiating primary prevention with statins in non-diabetic adults aged 70-89 according to their SCORE2-OP, and to explore risk thresholds for different ages. Methods We conducted an observational retrospective cohort study with the Catalan primary care database (SIDIAP) with an intention-to-treat approach. We assessed incident CVD (myocardial infarction and stroke), all-cause mortality, and adverse effects. Overall and age-stratified propensity-adjusted Cox proportional hazard models were fitted, using restricted cubic splines for the treatment interaction with SCORE2-OP. Results We analyzed 167,360 individuals (mean age 77.70 years; 36.9% men). The mean baseline SCORE2-OP risk was 13.81%. Overall, treatment was not associated with a CVD reduction in lower risks, with a protective association becoming stable around a SCORE2-OP of 16% (HR=0.90 [0.84-0.96]). The different age groups reached similar protective associations (HR ≈ 0.85), but at different estimated risks. A mild significant increase of type 2 diabetes was observed in statin initiators (1.07 [1.02-1.12]). We did not observe a protective association with all-cause mortality across the whole estimated risk spectrum. Conclusions Age-specific risk thresholds of the SCORE2-OP estimated risk may be further developed and considered when weighing the benefits of initiating primary prevention of incident CVD with statins in non-diabetic adults aged 70+. Our results do not support treatment initiation of primary prevention to reduce all-cause mortality at any level of estimated CVD risk.