Efficacy and safety of statin therapy in older people

Statin therapy has been shown to reduce major vascular events and vascular mortality in a wide range of individuals, but there is uncertainty about its efficacy and safety among older people.

In this study the researchers reviewed evidence from 28 trials in which the merits of statin treatment were compared with non-use. 14,483 (8%) of 186,854 participants in the 28 trials were older than 75 years at randomisation, and the median follow-up duration was 4.9 years. Participants were subdivided into six age groups: 55 years or younger, 56–60, 61–65, 66–70, 71–75 and older than 75 years. Major vascular events, cause-specific mortality and cancer incidence were documented.

The researchers conclude that statin therapy produces significant reductions in major vascular events irrespective of age, but there is less direct evidence of benefit among patients older than 75 years who do not already have evidence of occlusive vascular disease. This limitation is now being addressed by further trials. It was also noted that statin therapy had no effect at any age on non-vascular mortality, cancer death or incidence of cancer.

Lancet 2019; 393:407–15

Vitamin C deficiency in Australian hospitalised patients

Vitamin C has anti-oxidant properties and acts as a cofactor for several enzymes. Hypovitaminosis C has been associated with bleeding, endothelial dysfunction and death. The prevalence of hypovitaminosis C is unknown in Australian hospitalised patients, and its clinical relevance is uncertain.

This observational study included general medical patients in a tertiary-level hospital in Australia. Vitamin C levels were determined by high-performance liquid chromatography in 149 patients. 76.5% were found to have hypovitaminosis C. These patients were older and had higher C-reactive protein levels. The median length of stay (LOS) in hospital was two days longer and they had four-fold higher odds of staying in hospital for >.5 days than those with normal vitamin C levels.

Hypovitaminosis C is common in hospitalised patients and is associated with prolonged LOS. Further research is needed to ascertain the benefits of vitamin C supplementation in vitamin C-depleted patients.

Internal Medicine Journal 2019; 49:189–196

Randomised trial of endoscopic or open vein-graft harvesting for coronary-artery bypass

The saphenous-vein graft is the most common conduit for coronary-artery bypass grafting (CABG). The influence of the vein-graft harvesting technique on long-term clinical outcomes has not been well characterised.

This trial was devised to throw light on this important issue. One thousand one hundred and fifty patients undergoing CABG at 16 centres in the US were randomised to either open or endoscopic vein-graft harvesting. The end points were major adverse cardiac events and the need for repeat revascularisation. Leg wound complications were also evaluated.

At a median follow-up time of 2.78 years the researchers report that they did not find a significant difference between open vein-graft harvesting and endoscopic vein-graft harvesting in the risk of major adverse cardiac events. The need for repeat revascularisation were similar in both groups. Leg wound infections occurred in 3.1% of the open harvest group and in 1.4% of the endoscopic group.

N Engl J Med 2019; 380:132–41

‍