Statin therapy produces significant reductions in major vascular events irrespective of age, including in people older than 75 years, according to a new study published in The Lancet.
Statins produce significant reductions in major vascular events, but there is less direct evidence of benefit among patients older than 75 years who do not already have evidence of occlusive vascular disease. Image credit: Heung Soon.
“Statin therapy has been shown to prevent cardiovascular disease in a wide range of people, but there has been uncertainty about its efficacy and safety among older people,” said University of Sydney’s Professor Anthony Keech, lead author of the study.
“Our study summarized all the available evidence from major trials to help clarify this issue.”
Professor Keech and co-authors assessed the effects of statins in 186,854 people who had taken part in 28 large clinical trials.
Participants were divided into six age groups (under 55 years, 55-60, 60-65, 65-70, 70-75, and over 75 years) in order to assess the effects of statins on major vascular events (heart attacks/strokes/coronary revascularisations), cancer incidence and deaths.
“We found that there were significant reductions in major vascular events in each of the six age groups considered, including patients aged over 75 at the start of treatment,” Professor Keech said.
Statins help lower the level of low-density lipoprotein (LDL) cholesterol in the blood and are prescribed to millions of people globally. Having a high level of LDL cholesterol can lead to hardening and narrowing of the arteries and cardiovascular disease.
The study authors found that, overall, statin treatment reduced the risk of a major vascular event by about a quarter for each millimole per litre reduction in LDL cholesterol, even in older people.
In addition, they found that statin therapy did not increase the risk of deaths from non-cardiovascular disease, or the risk of cancer, at any age.
Cardiovascular risk reductions were observed, irrespective of age, in people with or without known vascular disease at the start of the trials.
The evidence was less extensive in people aged over 75 who did not already have evidence of vascular disease (those who were prescribed statin therapy for the ‘primary prevention’ of heart attacks and strokes).
“Statin therapy appears to be just as effective in people aged over 75 years as it is in younger people,” said co-author Dr. Jordan Fulcher, also from the University of Sydney.
“We have definitive evidence that statins benefit older people who have suffered a heart attack or stroke. Fewer healthy older people were represented in these trials, so more information in this group of people would help confirm the same benefits that we see in our overall trials population.”
“The risk of heart attacks and strokes increases markedly with age, and yet statins are not utilized as widely in older people as they should be. Since the risk of heart attack and stroke increases with age, the potential benefits are likely to be even greater for older people,” said co-author Professor Colin Baigent, from the University of Oxford.
“Therefore, there is a need to ensure that patients at risk of cardiovascular disease due to their age are offered statin therapy where there is good reason to believe that it will be beneficial. Anyone with concerns about whether statin therapy is suitable for them should discuss this with their GP.”
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Jordan Fulcher et al (Cholesterol Treatment Trialists’ Collaboration). 2019. Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials. The Lancet 393 (10170): 407-415; doi: 10.1016/S0140-6736(18)31942-1
