Research Supports Statins in the Elderly

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Statins decrease major vascular events like stroke and heart attack regardless of age. While the evidence is less robust for people over age 75, evidence suggest this age group may also benefit, finds a new study in The Lancet.

Statins are one of the mainstays for preventing cardiovascular events in people with high cholesterol.  While many studies have confirmed their benefits, few have included people over age 75.  That has left lingering questions about the safety and efficacy of statins in older people.

To address these questions, the Cholesterol Treatment Trialists' Collaboration analyzed 28 large research clinical trials of statin therapy compared to placebo or usual care. The analysis included over 185,000 individuals, of which 8 percent were over age 75. Participants took statins for about five years, on average.

For each 1.0 mmol/L decrease in LDL that resulted from statin use, the risk of major vascular events decreased by 21 percent overall. All age groups showed a significant decrease in major vascular events associated with statin use.

There was a significant trend towards smaller risk reduction with increasing age for major coronary events like heart attacks.

However, while results also showed a trend toward smaller risk reduction with increasing age for vascular mortality and major vascular events, the results were not significant. After excluding four trials of patients with heart and renal failure (who may benefit less from statins), results showed that older individuals still benefited from statins, in terms of reduced risk for vascular death and major vascular events.

Risk reduction for stroke and coronary revascularization procedures (like CABG) did not differ by age.

Results showed less evidence of benefits for statins in people over age 75 who do not already have vascular disease. But this is a small group for which more studies are needed.

Statins were not tied to cancer death, cancer incidence, or non-vascular death.

The researchers emphasized that the absolute benefit of decreasing LDL with statins may be substantial in older individuals. That’s because the absolute risk of major vascular events increases exponentially with age in untreated individuals.

They concluded: “Statin therapy produces significant reductions in major vascular events, irrespective of age. There is less definitive direct evidence of benefit in the primary prevention setting among patients older than 75 years, but evidence supports the use of statin therapy in older people considered to have a sufficiently high risk of occlusive vascular events.”

ABOUT THE AUTHOR

Veronica Hackethal,MD, MSc, is a medical journalist based in New York City who is a long-time contributor to the Modern Medicine Network publications. Her writing has also appeared in the New York Times, Chicago Tribune, NBCNews.com, Reuters Health, Nature Medicine News and Medscape. She is a graduate of Harvard University, Oxford University and Columbia College of Physicians and Surgeons (MD).

REFERENCE

Cholesterol Treatment Trialists' Collaboration. Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials. The Lancet. 2019;393:407-415. doi: 10.1016/S0140-6736(18)31942-1.