Heart disease danger for over-75s who discontinue statins

Statins are in the spotlight again, with new research finding that healthy over 75-year-olds who discontinue their use have an increased risk of heart disease.
 
The observational study, published in the European Heart Journal, looked at 120,173 people in France aged 75, who had been taking statins for two years.
 
It found discontinuing the lipid-lowering drug was associated with a 33% increased risk of admission to hospital for cardiovascular events. People aged over 75 who stopped taking statins had a 46% increased risk of a coronary event and a 26% increased risk of a blood vessel problem such as stroke.
 
‘To patients, we would say that if you are regularly take statins for high cholesterol, we would recommend you don’t stop the treatment when you are 75,’ lead author Dr Philippe Giral said.
 
‘To doctors, we would recommend not stopping statin treatment given for primary prevention of cardiovascular diseases in your patients aged 75.’
 
Dr Giral said the researchers estimated that an extra 2.5 cardiovascular events per 100 people would occur within four years among those who discontinued their statins at the age of 75 years, compared to those who continued taking the medication.
 
Dr Ingrid Hopper, from the Department of Epidemiology and Preventive Medicine at Monash University, told newsGP the clear message from the paper is that statins may well have advantages for this particular age group.
 
‘I certainly wouldn’t be routinely taking my patients off statins when they hit the age of 75,’ she said.
 
‘I would be considering their risk and weighing it up appropriately, and making a decision that’s right for that particular patient.’
 
Dr Hopper says the results of this paper are ‘fascinating’ and help address a common concern in primary care.
 
‘We’re not really sure about statin use in the elderly. The guidelines are unclear about whether we should use them in primary prevention,’ she said.
 
She added this exact topic is currently being researched at Monash University, in the StaREE trial (Statins in Reducing Events in the Elderly).
 
‘We know statins are really valuable for secondary prevention,’ she said.
 
‘If you’ve had a heart attack or had a stroke, we know it’s really good at reducing your risk of having it a second time, but most of the trials in primary prevention have been done in younger populations.’
 
The Monash University research hopes to examine whether statins increase the quality of life in an older population. Dr Hopper believes the choice of whether to use statins in that population for that purpose is currently ‘so muddy’.
 
Dr Giral’s study follows on from previous research, published in February this year in The Lancet, which sought to address the issue of the safety and efficacy of statins among older people.
 
That meta-analysis found that overall, statin therapy or a more intensive statin regimen, produced a 21% proportional reduction in major vascular events per 1.0mml/L reduction in LDL cholesterol.
 
While that study found that statins are safe and effective in patients aged over 75, this new research goes a step further in highlighting its benefits.
 
However, not all research paints statins in a positive light, with two previous studies – one in Diabetes/Metabolism Research and Reviews, the other in the British Journal of Clinical Pharmacology – drawing potential links between the commonly-prescribed medication and the development of type 2 diabetes.
 
Dr Hopper says more research is needed into the use of statins in those aged over 70, but says for now this new paper contributes to much-needed dialogue into the area.
 
‘It’s a hypothesis-generating paper, so it doesn’t give us full answers,’ she said.
 
‘But it’s a fascinating result.’  

cholesterol heart disease statins