Statins safe to prescribe in people over 75 years of age

The study, published in The Lancet and conducted in part by University of Sydney researchers, compared the effects of statin therapy in almost 187,000 people who had taken part in 28 large clinical trials.
 
Participants were divided into six different age groups ranging from 55–75 years of age, which were subsequently assessed to discover the effect statins had on major vascular events, cancer incidence and death.
 
It found that statin treatment reduced the risk of a major vascular event by around a quarter for each millimole per litre reduction in low-density lipoprotein (LDL) cholesterol, with similar benefits across all ages, including people aged 75 years and over.
 
Furthermore, the researchers confirmed that statin therapy did not increase the risk of cancer or deaths from non-cardiovascular disease, at any age.
 
‘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 over 75 years,’ lead investigator from the University of Sydney, Professor Anthony Keech said.
 
‘Our study summarised all the available evidence from major trials to help clarify this issue, and found that there were significant reductions in major vascular events in each of the six age groups considered, including in patients aged over 75 years at the start of treatment.’
 
Previously, most individual statin trials had defined ‘elderly’ people as those aged 65 years and over. However, ever-increasing life expectancies have meant researchers are now required to consider older groups when determining the effectiveness of treatments in older people.
 
According to co-investigator Dr Jordan Fulcher, also from the University of Sydney, the new study will provide reassurance and guidance for doctors and patients that people are not automatically ‘too old’ for treatments like statins to be effective.
 
‘Our analysis found that statin therapy appears to be just as effective in people aged over 75 years as it is in younger people. We now have definitive evidence that statins benefit older people who have suffered a heart attack or stroke,’ he said.
 
Fulcher’s fellow researcher, Professor Colin Baigent from the University of Oxford, added that statins are not currently being used 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,’ Professor Baigent said.  
 
‘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.’
 
However, while the study was a success, the evidence was less conclusive with respect to people aged over 75 years who had no pre-existing vascular disease and were instead prescribed statin therapy for primary prevention of heart attacks and strokes. As such, new randomised trials have been created to further study the effects of statins in apparently healthy older people.
 
‘More information in this group of people would help confirm the same benefits that we see in our overall trials population,’ Dr Fulcher said.
 
‘A new randomised trial in Australia, called StaREE [Statins in Reducing Events in the Elderly], is specifically exploring whether statin treatment can prolong survival free of disability in a healthy elderly population.’
 
The study was conducted by the Cholesterol Treatment Trialists’ (CTT) Collaboration, a joint initiative coordinated between the University of Sydney’s National Health and Medical Research Council (NHMRC) Clinical Trials Centre, and Oxford’s Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), on behalf of academic researchers representing major statin trials worldwide.

Cardiovascular disease Cholesterol heart attack Medical research Older people Statins Stroke