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GPs go forth

Statins cut risk of heart attacks and stroke in over 75s, study claims

GPs can prescribe statins to patients aged over 75 to effectively cut the risk of vascular events – such as heart attack and stroke - and reduce vascular mortality, according to a new study.

Researchers from the Cholesterol Treatment Trialists’ Collaboration, looked at the efficacy and safety of statin therapy in older people and found it reduces major cardiovascular events, regardless of age.

But GPs said while the study suggested statins may be offered to patients over the age of 75, more evidence is needed for those over the age of 85, and that many older patients would decline statins if offered them anyway.

The research team carried out a meta-analysis of randomised trials of statin therapy, which included at least 1,000 participants receiving treatment for at least two years.

In total, they included 28 trials and 301,649 patients, estimating effects on major vascular events, and cause-specific mortality.

Of these, 186,854 patients were aged 55 years or younger, 31,434 (17%) were 56–60 years, 37,764 (20%) were 61–65 years, 36,567 (20%) were 66–70 years, 27,314 (15%) were aged 71–75 years, and 14,483 (8%) were older than 75 years

The study found statin therapy or a more intensive statin regimen produced a 21% proportional reduction in the risk of a first major vascular event (per 1·0 mmol/L reduction in LDL cholesterol), compared with control therapy.

Independently significant risk reductions in each of the age groups was seen, including in those over 75 years at the start of treatment, the paper said.

The researchers said although proportional reductions in major vascular events ‘diminished slightly with increasing age, this trend was not statistically significant’.

The study also saw a 12% proportional reduction in vascular mortality per 1·0 mmol/L reduction in LDL cholesterol, with a ‘trend towards smaller proportional reductions with older age’ - however this reduction did not persist after exclusion of the heart failure and dialysis trials.

The paper, published in the Lancet, said: ‘Statin therapy produces significant reductions in major vascular events irrespective of age, but there is less direct evidence of benefit among patients older than 75 years who do not already have evidence of occlusive vascular disease.

‘This limitation is now being addressed by further trials.’

Professor Azeem Majeed, head of primary care and public health at Imperial College London and a GP in south London, said: ‘Only 8% of the participants were aged over 75. We would need a separate analysis to show the efficacy of statins in the very elderly.

‘The small number of people aged over 85 in this current meta-analysis would result in this analysis having limited power to show any effect of statins in reducing cardiovascular events and deaths.

‘The results do though suggest that statins can be offered to people in the range of 75-85 years if they have no contra-indication.

‘In practice, many people in this group may decline statins if offered to them and it’s important that doctors enter a suitable code for “statin declined” to show that the patient has been offered a statin but that it was the patient’s decision to decline to take one.’

Readers' comments (5)

  • We all die of something; a very elderly patient who is less likely to die from cardiovascular disease is therefore more likely to die from cancer, dementia etc. Are we sure that is what our patients want?

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  • the control group was made up of patients on statins on low doses or no statin compared to high dose statin, only 10% smoked compared to 21% under 75 years and the average age was 79 years. so you are not comparing the population to people who are not on statins. its difficult to interpret the data for this reason. when we advise people its about whether to start one or not so the trials should be - in over 75 years starting on a statin compared to not being on one, does it reduce the risk and what is the side effect profile? - How much of the risk reduction was due to people stopping smoking? otherwise the information is unhelpful in primary care. perhaps the researches should be asking us what questions we need answering before they do the research.

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  • AlanAlmond

    They're all going to die of something, statistically on average the men within 4 years of their 75th birthday, the women within 7. If it ain't cardiovascular disease it'll be cancer/kidney failure/dementia/sepsis/bronchopneumonia..or something else. Statins won't stop anyone from dying that's for sure

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  • @AlanAlmond

    I agree entirely with your logic but not your statistics: life expectancy for a UK man age 75 is 12 years, not 4.

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  • AlanAlmond

    forgive me ..i googled it and got my stats from the sun - that's where most of my figures come from these days

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