Statins do not reduce heart disease among the old, study finds

A new study does not support the widespread use in healthy older people of statins as cholesterol reducing drugs, in order to prevent heart disease and stroke.

The observational study, published by the British Medical Journal, found any protective effect of statins was limited to people aged between 75 and 84 with Type 2 diabetes.

Statin prescriptions to elderly patients have increased in recent decades but statins are not associated with reducing cardiovascular disease (CVD) or death in healthy people aged over 75, the study found.

In cases of those with Type 2 diabetes, statins were related to a reduction in CVD and death from any cause up to the age of 85 years, it found.

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CVD is the leading cause of death globally, especially for those aged 75 and over.

The authors concluded their results do not support widespread use of statins in old and very old populations but do support treatment in those with Type 2 diabetes younger than 85.

Using data from the Catalan primary care system database, the research identified 46,864 people aged 75 years or more with no history of cardiovascular disease between 2006 and 2015.

In participants without diabetes, statins were not associated with a reduction in CVD or all cause mortality in both old and very old age groups. In participants with diabetes, statins were associated with significantly reduced levels of CVD (24 per cent) and all cause mortality (16 per cent) in those aged 75-84 years.

This protective effect declined after age 85 and disappeared by age 90, the research found.

Because the study was observational, the authors said no “firm” conclusions can be drawn about cause and effect but said it was a high quality study with a large sample size, reflecting real life clinical conditions.

Reacting to the study, Dr Angie Brown, a consultant cardiologist and medical director with the Irish Heart Foundation, said statins have been proven in many large scale randomised trials to be beneficial for both secondary prevention (following a stroke or heart attack) and primary prevention in patients with a significant risk of developing CVD disease but there was less evidence for effectiveness in patients over 80.

The study suggests no benefit of statins in healthy people over 75 but did show a significant benefit in patients with diabetes, she said.

As it was an observational study, no firm conclusions can be drawn as some of their results may be due to unmeasured factors, she cautioned. “As age is a dominant driver of risk we know the biggest challenge for clinicians is how to more appropriately stratify risk in individuals aged more than 75 years of age.”

The study’s observational findings need to be tested further in randomised trials but patients shoud in the meantime continue with their medication as prescribed and discuss their particular situation with their doctor if they have any concerns, she said.

Sherif Sultan, professor of vascular and endovascular surgery at NUI Galway, was generally critical of research on statins and said this latest study "fuels concerns and criticism".

The totality of evidence to date reveals, for the “overwhelming majority” of people, the lowering of LDL or ‘bad’ cholesterol by drugs “has no benefit and comes with significant quality of life interfering side effects”, he said.

One of the most interesting findings was that elderly people with the highest LDL cholesterol levels lived longer than elderly people on statin treatment, he said. “A reasonable question is therefore: Why should we lower the bad cholesterol if those with the highest values live the longest?”

[ Is statin use a waste of time and money? ]